RPS 809 - From tissue to therapy: innovations in biopsy and ablation

Author Block: R. J. Ocker-Serger¹, M. Opitz¹, B. M. Schaarschmidt¹, L. V. Klüner¹, M. A. Drews¹, J. Haubold¹, J. Nadjiri², S. Zensen¹; ¹Essen/DE, ²Munich/DE
Purpose: To assess the technical success, diagnostic yield, and complication profile of image-guided percutaneous renal biopsies in a real-world, multicenter setting.
Methods or Background: This retrospective registry analysis included 5,235 renal biopsies performed between 2018 and 2024 at 176 centers in Germany, Austria, and Switzerland. Technical success was defined as confirmed needle placement within the target lesion. Diagnostic yield referred to histological adequacy for clinical decision-making. Complications were classified according to the Society of Interventional Radiology (SIR) grading system.
Results or Findings: Technical success was achieved in 98.4% (5,150/5,235) of interventions, and diagnostic yield was 94.9% (3,943/4,154). Outpatient procedures showed slightly higher technical success (99.3%, 267/269) than inpatient procedures (98.3%, 4,883/4,966; p = 0.241), with comparable diagnostic yield and safety profiles. The overall complication rate was 5.0% (264/5,235), with major complications in 0.7% (39/5,235). Bleeding was the most frequent complication, including venous (33.0%), parenchymal (30.3%), and arterial (17.1%) events. Coagulation abnormalities were significantly associated with higher complication rates.
Conclusion: Image-guided percutaneous renal biopsies are effective and safe across a large multicenter cohort. The results support their use in outpatient settings, provided coagulation status is optimized and adequate tissue sampling is achieved
Limitations: The main limitations of this registry-based study are potential selection bias, reliance on site-reported data with incomplete documentation, and the absence of a central histopathological review.
Funding for this study: No funding for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Local ethic committee University Duisburg-Essen 22-10865-BO

Author Block: S. Inturri¹, E. Raimondi¹, M. Tilli¹, M. Dugo¹, F. Ermili¹, M. Montesi¹, R. Bisi², M. Bandi¹, R. Rizzati¹; ¹Lagosanto/IT, ²Ferrara/IT
Purpose: To evaluate whether saturation target biopsy (sTB) alone can replace the combined approach of sTB plus systematic biopsy (SB) for csPCa detection in patients with PI-RADS ≥3 lesions on multiparametric MRI (mpMRI).
Methods or Background: We retrospectively analyzed 390 MRI–US fusion biopsy patients with single prostatic lesion PI-RADS ≥3 at mpMRI. Patients were divided into three groups according to PI-RADS score: n=77 with PI-RADS 3 (19.8%), n=186 with PI-RADS 4 (47.6%), and n=127 with PI-RADS 5 (32.6%). For each group, histology from target (T), regional saturation target (RST), and contralateral systematic biopsy (CSB) was compared. Patients were then classified as negative, T and/or RST ≥ to CSB, or T and/or RST < to CSB.
Results or Findings: In the PI-RADS 3 group, histology was negative in 52 patients (67.5%), positive with T and/or RST ≥ to CSB in 18 patients (23.4%), and positive with T and/or RST < to CSB in 7 patients (9.1%). In the PI-RADS 4 group, histology was negative in 20 patients (10.7%), positive with T and/or RST ≥ to CSB in 161 patients (86.6%), and positive with T and/or RST < to CSB in 5 patients (2.7%). In the PI-RADS 5 group, histology was negative in 4 patients (3.1%), positive with T and/or RST ≥ to CSB in 120 patients (94.5%), and positive with T and/or RST < to CSB in 3 patients (2.4%). Only 7 out of 390 patients (1.8%) were positive exclusively at CSB. Among these, 5 (71.5%) had Gleason score 3+3 (ISUP 1), while 2 (28.5%) had Gleason score 3+4 (ISUP 2).
Conclusion: SB in addition to sTB provided no significant additional diagnostic value for csPCa in patients with PI-RADS ≥3 lesions on mpMRI.
Limitations: Not applicable
Funding for this study: No funding was provided for this study
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: G. Viviano, A. Adebanjo, M. De Filippo; Parma/IT
Purpose: This study evaluates whether saline infiltration during coaxial needle extraction reduces the incidence of pneumothorax (PTX) in CT-guided lung biopsies, potentially enhancing procedural safety.
Methods or Background: A retrospective analysis of 200 consecutive CT-guided core needle biopsies (18G) was conducted using our hospital’s Radiology Department database. All procedures were performed between February 2022 and December 2024 by a single operator with 20 years of experience. Patients were divided into two groups: Group A (100 patients), receiving 5–10 ml of 0.9% saline solution during coaxial needle extraction, and Group B (100 patients), where no saline was infiltrated. Descriptive and inferential statistical analyses assessed the relationship between saline infusion and PTX incidence.
Results or Findings: PTX occurred in 24% of Group B patients versus 7% in Group A (p < 0.001). Multivariate analysis confirmed saline infusion as a significant protective factor, even in high-risk patients (e.g., those with severe emphysema or in lateral decubitus). The odds ratio (OR = 3.9) indicates that the absence of saline increases PTX risk nearly fourfold.
Conclusion: Saline infiltration during coaxial needle removal significantly reduces PTX incidence in CT-guided lung biopsies, offering a simple, effective strategy to enhance patient safety.
Limitations: None
Funding for this study: None
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: Università di Parma

Author Block: N. R. Mahboobani, P. Chan, K. H. LEE, C. Tsai, J. F. Griffith; Hong Kong/HK
Purpose: Histotripsy uses high intensity pulsed ultrasound waves to mechanically destroy targeted tissue whilst sparing surrounding tissues and structures. We report results and experience from one of the first sites in Asia using histotripsy to treat focal liver lesions.
Methods or Background: 19 patients (12 males, 7 females) with mean age of 70.5 years had 22 focal liver lesions treated with histotripsy between April and September 2025. All treatment procedures were done under general anaesthesia. Clinical parameters, laboratory test results and imaging were reviewed.
Results or Findings: 15 hepatocellular carcinomas and 7 liver metastases were treated. Mean size of the lesions was 2.2 cm (range 0.9 to 4.0 cm). 21 lesions were successfully treated as evident by liquefaction on post-treatment day 1 MRI, with technical success rate 95.4%. One small lesion in segment I showed no treatment related changes on post-treatment day 1 MRI. One patient developed transient thrombosis in right portal vein branch which subsequently resolved on day 7. Minor complications included transient derangement of liver function (15 patients), mild ascites (8), mild abdominal wall oedema (5), and mild right pleural effusion (4). All minor complications subsequently resolved. 17 patients have had post-treatment 1 month MRI, out of which 8 have also had post-treatment 3 month MRI. These show progressive shrinkage of the liquefied treatment volume with no evidence of recurrence.
Conclusion: Histotripsy is an effective non-invasive treatment for focal liver lesions which can be clearly visualised on ultrasound. It is suitable for lesions which are in close proximity to structures such as the biliary tract or vessels. Patient and lesion selection, patient positioning and ventilation strategies during general anaesthesia to reduce respiratory excursion of the liver are important factors for successful treatment.
Limitations: No limitations were identified.
Funding for this study: No funding was received for this study.
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: The study was approved by The Chinese University of Hong Kong Medical Centre (CUHKMC CREC-202504)

Author Block: H. Whittaker, V. Chan, R. Miller, J. Cartledge, J. Zhong, O. Abdel-Hadi, J. Smith, J. Lenton, T. M. Wah; Leeds/UK
Purpose: Long-term renal function post image-guided ablation (IGA) and partial nephrectomy (PN) is underreported. This study aims to outline the ultra-long term renal function of IGA and PN patients.
Methods or Background: This is a retrospective study of localised RCC (T1) patients undergoing image-guided cryoablation, radiofrequency ablation (RFA) or laparoscopic PN from 2004-2015 at our institution. Cox regression and log-rank analysis were used for survival analysis of long-term renal function, alongside t-test, chi-squared tests.
Results or Findings: A total of 295 patients undergoing image-guided cryoablation (104), image-guided RFA (99), and laparoscopic PN (92) were included. Median follow-up was 136 months (IQR 76). IGA patients were older (mean difference 13.8 years, p<0.001) and more comorbid (mean difference in Charlson index 1.47, p<0.001). Pre-treatment CKD is significantly more prevalent in patients undergoing IGA (29.1%) than PN (10.9%) (p=0.001). At 10-years follow-up, eGFR decreased 16.6% in IGA vs 8.4% in PN (p=0.12). New CKD (Grade 3 or above) developed in 28.3% of IGA patients vs 15.2% of PN patients (p=0.027) at follow-up. However, on a multivariable cox regression model, when taking account into age and Charlson comorbidity index, new-CKD free survival is similar between IGA and PN (HR 0.72, 95% CI 0.34-1.52, p=0.390). Six patients underwent renal dialysis, all IGA patients due to pre-treatment CKD. CKD-specific deaths were similar (HR 0.26, 95%CI 0.03-2.2, p=0.218).
Conclusion: Despite an older, co-morbid population pre-treatment, IGA achieved similar ultra-long-term renal function to PN.
Limitations: However, this study is limited by selection bias, and long-term results from randomised trials are warranted.
Funding for this study: No funding.
Has your study been approved by an ethics committee? Not applicable
Ethics committee - additional information:

Author Block: G. Liang, S. Huang, W. Xiao, S. Gong; Hangzhou/CN
Purpose: To evaluate the safety and efficacy of cryoablation for pulmonary metastases and investigate its differential impact on targeted versus non-targeted lesions.
Methods or Background: This retrospective study included 74 patients (39 male, mean age 61.7±8.3 years) with 102 pathologically proven pulmonary metastases treated with cryoablation between July 2020 and September 2024. Demographics, lesion characteristics, procedural details, and complications were recorded. Patients underwent follow-up CT scans at 3, 6, and 12 months. The primary outcome was the progression status of the targeted lesion at one year. Secondary outcomes included the progression of non-targeted lesions at each interval and overall survival. Changes in lesion size (length/short-diameter) were evaluated.
Results or Findings: The most common primary cancer was colorectal cancer (72%). The procedure was technically successful in all cases. Complication rates were low, with 24% of patients experiencing minor events (e.g., pneumothorax, hemoptysis); only two cases (2%) required chest tube drainage for moderate pneumothorax. For targeted lesions, larger lesion size (length and short-diameter) and a shorter distance from the ablation margin significantly predicted local progression (all p<0.001). For non-targeted lesions, the location of the ablated metastasis was a significant predictor of progression. Treating subpleural lesions resulted in significantly better control of non-targeted metastases at 3, 6, and 12 months compared to intrapulmonary lesions (Odds Ratios: 0.33, 0.33, 0.38; all p<0.05).
Conclusion: Cryoablation is a safe and effective treatment for pulmonary metastases. Outcomes for targeted lesions are influenced by their size and the achieved ablation margin. Notably, ablating subpleural metastases is associated with superior subsequent control of non-targeted lesions, suggesting a potential systemic benefit.
Limitations: The retrospective nature of this study.
Funding for this study: This study has received funding by National Natural Science Foundation of China (NSFC, No. 82330060 and 82370738).
Has your study been approved by an ethics committee? Yes
Ethics committee - additional information: This study was approved by Clinical Research Ethics Committee of the First Affiliated Hospital of Zhejiang University School of Medicine (IIT20240466A)