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Dr Wa Cheung
Dr Stuart Lyon
Date last modified: April 10, 2015
Radiofrequency ablation is a procedure carried out to remove diseased tissue or a tumour (a lump) from the body. It is one type of what is called tumour ablation (or removal).
Tumour ablation is where a needle is placed directly into a tumour so that a chemical (usually alcohol or acetic acid) or thermal (heat or ice) treatment can be applied to destroy or reduce the tumour. Although tumour ablation has been used for a long time, only in the last 15 years has it been increasingly used to treat tumours. This is due to increasing technologies both in ablation and in imaging guidance. Imaging guidance is the use of X-rays, computerised tomography (CT), ultrasound (US) or magnetic resonance imaging (MRI) to allow accurate positioning of the ablation needle within the tumour or tumours.
Radiofrequency ablation is the most commonly carried out tumour ablation procedure. Radiofrequency uses an electric current that moves back and forth to create heat within the tumour. A needle is used to produce heat within the tumour or tumours to completely or significantly destroy the tumour or tumours. This is usually carried out under image guidance to ensure the needle is placed correctly within the tumour or tumours.
Tumours of the liver, kidney, lung or bone that are benign (non-cancerous) or malignant (cancerous) are being increasingly treated with radiofrequency ablation. Although many of these tumours can be completely treated with radiofrequency ablation, surgery remains at this time the best and most complete treatment. Radiofrequency ablation is used when surgery is thought to be too risky (patient fitness or location and number of tumours) or for palliation (improving quality of life or length of life, but not completely destroying the tumour). Occasionally, radiofrequency ablation may be the best treatment due to it being less invasive than surgery, such as in some benign tumours of the bone.
The technology of tumour ablation and radiofrequency ablation is continuing to grow and it is likely that these technologies will continue to improve over the next few decades.
The need for having a procedure to destroy or reduce a tumour is usually assessed using ultrasound, CT scan or MRI, and sometimes all three. These imaging tests will be used to determine the size, location and other features of the tumour as a guide for planning the procedure. The test will also be used in future assessment of the response to treatment. Blood tests will also be carried out to ensure there are no medical reasons why radiofrequency ablation should not be used and the test results will be used to assess tumour markers (features or signs). Fasting (no food or fluid) is usually required for a few hours before the procedure.
You will generally be admitted to hospital or to a day procedure centre on the day of the procedure if you are not already in hospital. Radiofrequency ablation can be carried out under general anaesthetic, where you will be asleep and monitored by an anaesthetist (specialist doctor). Alternatively, you may be awake, but sedation medication will be given to ensure you are drowsy and relaxed.
Monitored by the anaesthetist, you will be taken to the medical imaging or radiology department of the hospital where you are having the procedure.
The area where the needle electrode will be inserted is cleaned with antiseptic solution and covered with a surgical drape. Grounding pads are laid on the skin, usually on both thighs, so that the electrical current can be safely applied while the radiofrequency ablation is carried out. Then the area will be numbed with a local anaesthetic if the procedure is carried out without general anaesthetic. A very small cut is made in the skin after it is numb and then the radiofrequency ablation needle electrode is inserted into the tumour being treated using imaging guidance, usually ultrasound, sometimes CT scanning, and images or pictures are shown on a screen. Once the electrode is in place, the electrical current is applied. Heat may be felt during the procedure. At the end of the procedure, the electrode will be removed and pressure will be applied to the site where the needle was inserted, to stop any bleeding. The opening in the skin is covered with a dressing. No stitches are required.
Each radiofrequency ablation session takes approximately 15–30 minutes. For larger cancers, it may be necessary to carry out multiple ablations by repositioning the needle electrode into different parts of the tumour to ensure no cancer tissue is left behind. The entire procedure is usually completed within 1–3 hours.
A radiologist (specialist doctor) will use ultrasound or CT images to guide the insertion of the needle electrode through the skin and into the tumour or tumours being treated. A radiologist is a doctor who has specialised in medical imaging and image-guided treatments. Rarely, the procedure will be carried out during an operation by a surgeon.
Radiofrequency ablation is usually carried out within a hospital by a radiologist. You may go home on the same day or stay for one night.
The cells in the tumour will die immediately after the radiofrequency ablation. The exact extent of cells killed during the procedure may be obscured by inflammation, a natural body reaction to the procedure. The inflammation will gradually decrease in 1 or 2 weeks. A CT scan, or rarely an MRI scan, will be taken within 1 month after your treatment to assess the results of the procedure.
It is important to realise that a period of follow up is required after radiofrequency ablation. It often takes a year (sometimes longer) to be certain that the tumour is treated. This requires both imaging and visits to your specialist doctor.
Cardiovascular and Interventional Radiological Society of Europe: