ABSTRACT Objective: This study assessed the cost-effectiveness of radiofrequency ablation compared with percutaneous ethanol injection in patients with early hepatocellular carcinoma in relation to the objective response rate and costs related to the procedure. Methods: This was a prospective single-center randomized trial. The primary outcome was cost-effectiveness. Secondary outcomes were the complete response rate according to the modified response evaluation criteria in solid tumors 60 days after randomization and the complication rate within 180 60 days. Results: Fifty patients were placed into the following groups: percutaneous ethanol injection (n=23) and radiofrequency ablation (n=27). Fifty-four nodules were randomized (mean follow-up: 205.37 days). The estimated mean hospital cost was US$ 1854.11 and US$ 2770.96 for the Radiofrequency Ablation and Percutaneous Ethanol Injection Groups, respectively. The incremental cost-effectiveness ratio was US$ -2674.59, which is advantageous for radiofrequency ablation. After 60 d, 28 of 29 nodules in the Radiofrequency Ablation Group achieved complete response versus 12 of 22 in the Percutaneous Ethanol Injection Group (RD, 42.01 [95%CI= 20.55–63.24]; p<0.001). Only four early complications were observed among patients treated by percutaneous ethanol injection (p<0.05). Late complications occurred in two and one patient(s) in the Radiofrequency Ablation and Percutaneous Ethanol Injection Groups (p>0.05), respectively. Conclusion: Radiofrequency ablation was more cost-effective and achieved higher complete response and lower complication rates than the Percutaneous Ethanol Injection Group within this cohort. Registry of Clinical Trials: NCT06450613 Objective costeffectiveness effectiveness procedure Methods singlecenter single center trial costeffectiveness. effectiveness. 6 18 Results groups n=23 n23 n 23 (n=23 n=27. n27 n=27 . 27 (n=27) Fiftyfour followup follow up follow-up 20537 205 37 205.3 days) US 185411 1854 11 1854.1 277096 2770 96 2770.9 respectively 2674.59, 267459 2674 59 -2674.59 d 2 1 RD, RD (RD 4201 42 01 42.0 95%CI= 95CI CI 95 [95%CI 20.55–63.24 20556324 20 55 63 24 20.55–63.24] p<0.001. p0001 p p<0.001 0 001 p<0.001) p<0.05. p005 p<0.05 05 (p<0.05) patient s patient(s p>0.05, p>0.05 , (p>0.05) Conclusion costeffective effective cohort Trials NCT NCT0645061 n=2 n2 (n=2 (n=27 2053 3 205. 18541 185 1854. 27709 277 9 2770. 2674.59 26745 267 5 -2674.5 420 4 42. 95%CI 20.55–63.2 2055632 p000 p<0.00 00 p00 p<0.0 (p<0.05 p>0.0 (p>0.05 NCT064506 n= (n= 2674.5 26 -2674. 20.55–63. 205563 p0 p<0. (p<0.0 p>0. (p>0.0 NCT06450 (n 2674. -2674 20.55–63 20556 p<0 (p<0. p>0 (p>0. NCT0645 -267 20.55–6 2055 p< (p<0 p> (p>0 NCT064 -26 20.55– (p< (p> NCT06 -2 20.55 (p NCT0 - 20.5 20.

ABSTRACT Radical treatment for prostate cancer is associated with significant morbidity. Percutaneous image-guided irreversible electroporation is a non-thermal ablative technique that has emerged as a valuable option. This study describes the case of a patient with prostate cancer who was successfully treated using irreversible electroporation. We report the case of a 72-year-old male patient who presented with elevated PSA (4.0ng/mL) during routine testing. Multiparametric magnetic resonance imaging of the prostate revealed a 0.8 cm lesion in the posterolateral aspect of the right midgland with marked hypointensity on ADC (ACR PI-RADS 4). The transperineal prostate revealed acinar adenocarcinoma (Gleason Score 3+3=6; International Society of Urological Pathology=1). Serum PSA levels reduced to 1.04ng/mL 32 days after the procedure and remained within normal limits (1.26ng/mL) after 349 days. Follow-up imaging performed 90 days later with prostate-specific membrane antigen PET/MRI showed size reduction, retraction, and diffuse hypointensity in the peripheral zone of the right prostate lobe, with no increase in prostate-specific membrane antigen uptake. Magnetic resonance imaging found no suspicious lesions 367 days after irreversible electroporation. At the final clinical follow-up at 390 days, the patient was asymptomatic. Our findings illustrate the potential of irreversible electroporation as a possible alternative treatment for prostate cancer. morbidity imageguided image guided nonthermal non thermal option 72yearold yearold 72 year old 4.0ng/mL 40ngmL ngmL 4 0ng mL ng (4.0ng/mL testing 08 0 8 0. ACR PIRADS PI RADS 4. . 4) Gleason 3+3=6 336 3 6 Pathology=1. Pathology1 Pathology Pathology=1 1 Pathology=1) 104ngmL 04ng 1.26ng/mL 126ngmL 26ng (1.26ng/mL 34 Followup Follow up 9 prostatespecific specific PETMRI PET MRI reduction retraction lobe uptake 36 followup follow 39 asymptomatic 7 3+3= 33 Pathology= 3+3 3+

ABSTRACT Purpose To analyze the learning curve regarding complication rates of transrectal prostate biopsy (TRPB) versus transperineal prostate biopsy (TPPB), using real time software-based magnetic resonance imaging ultrasound (MRI-US) fusion techniques, along with first year experience of transperineal approach. Materials and Methods retrospective unicentric cohort study at a quaternary care hospital. Medical records of all consecutive patients that underwent TPPB between March 2021 and February 2022, after the introduction of MRI-US fusion device, and those who underwent TRPB throughout the entire years of 2019 and 2020 were analyzed. All complications that occurred as consequences of the procedure were considered. Descriptive statistics, Chi-squared and Fisher tests were used to describe complications and compare the two groups. Results A total of 283 patients were included in the transperineal group and 513 in the transrectal group. The analysis of a learning curve for the transperineal method showed lower complications rates comparing the first six months of TPPB procedures (group 1); The complication rate for TPPB was lower than that of TRPB (55.1% versus 81.9%, respectively; p<0.01). TPPB showed specifically lower rates of hematuria (48.8% versus 66.3%;p<0.001) and rectal bleeding(3.5% versus 18.1%; p<0.001). There were no cases of prostatitis after transperineal biopsies and three cases (0.6%) after transrectal procedures. Conclusions We evidenced the learning curve for performing the transperineal biopsy, with a lower rate of complications for the experienced team, after 142 cases after 6 months of practice. The lower complication rate of TPPB and the absence of infectious prostatitis imply a safer procedure when compared to TRPB. (TRPB TPPB, , (TPPB) softwarebased software based MRIUS MRI US (MRI-US techniques approach hospital 202 2022 device 201 analyzed considered statistics Chisquared Chi squared groups 28 51 1 1) 55.1% 551 55 (55.1 819 81 9 81.9% respectively p<0.01. p001 p p<0.01 . 0 01 p<0.01) 48.8% 488 48 8 (48.8 66.3%p<0.001 663p0001 66.3% p<0.001 66 3 001 66.3%;p<0.001 bleeding3.5% bleeding35 bleeding 3.5% 5 bleeding(3.5 18.1% 181 18 p<0.001. p0001 p<0.001) 0.6% 06 (0.6% team 14 practice (TPPB 20 2 55.1 (55. 81.9 p00 p<0.0 48.8 4 (48. 66.3%p<0.00 663p000 663 66.3 p<0.00 00 66.3%;p<0.00 bleeding3 bleeding3.5 35 3.5 bleeding(3. 18.1 p000 0.6 (0.6 55. (55 81. p0 p<0. 48. (48 66.3%p<0.0 663p00 66. 66.3%;p<0.0 bleeding3. 3. bleeding(3 18. 0. (0. (5 p<0 (4 66.3%p<0. 663p0 66.3%;p<0. bleeding( (0 ( p< 66.3%p<0 663p 66.3%;p<0 66.3%p< 66.3%;p< 66.3%p 66.3%;p

ABSTRACT Lymphoceles are collections of lymphatic fluid, mainly caused by major surgical approaches. Most lymphoceles are asymptomatic and limited, but some cases may require a medical management. Among the different techniques, transafferent nodal embolization has emerged as a minimally invasive option, with low morbidity and high resolubility, although it is not widespread in the Brazilian scenario. In this study, we report a case of lymphocele drained percutaneously, with maintenance of high output and requiring transafferent nodal embolization.

ABSTRACT Objective To describe an experience in the preoperative localization of small pulmonary nodules and ground-glass lesions to guide minimally invasive thoracic surgery; in addition, a literature review was conducted, including the main advantages and disadvantages of the different agents used, and site marking in a hybrid operating room. Methods A retrospective search was conducted in a Interventional Radiology Department database, between March 2015 and May 2019, to identify patients undergoing preoperative percutaneous marking of lung injuries measuring up to 25mm. Results A total of 20 patients were included and submitted to descriptive analysis. All patients were marked in a hybrid room, at the same surgical-anesthetic time. Most often used markers were guidewire, Lipiodol® and microcoils. Despite one case of coil displacement, two cases of pneumothorax, and one case of hypotension after marking, all lesions were identified and resected accordingly from all patients. Conclusion Preoperative percutaneous localization of lung injuries in hybrid room is an effective and a safe technique, which can have decisive impact on surgical resection. The choice of marker and of the operating room scenario should be based on availability and experience of service. Multidisciplinary discussions with surgical teams, pathologists, and interventional radiologists are crucial to improve outcome of patients.

ABSTRACT Purpose: Ultrasound-magnetic resonance imaging (US-MRI) fusion biopsy (FB) improves the detection of clinically significant prostate cancer (PCa). We aimed to compare the Gleason upgrading (GU) rates and the concordance of the Gleason scores in the biopsy versus final pathology after surgery in patients who underwent transrectal ultrasound (TRUS) systematic random biopsies (SRB) versus US-MRI FB for PCa. Materials and Methods: A retrospective analysis of data that were collected prospectively from January 2011 to June 2016 from patients who underwent prostate biopsy and subsequent radical prostatectomy. The study cohort was divided into two groups: US-MRI FB (Group A) and TRUS SRB (Group B). US-MRI FB was performed in patients with a previous MRI with a focal lesion with a Likert score ≥3; otherwise, a TRUS SRB was performed. Results: In total, 73 men underwent US-MRI FB, and 89 underwent TRUS SRB. The GU rate was higher in Group B (31.5% vs. 16.4%; p=0.027). According to the Gleason grade pattern, GU was higher in Group B than in Group A (40.4% vs. 23.3%; p=0.020). Analyses of the Gleason grading patterns showed that Gleason scores 3+4 presented less GU in Group A (24.1% vs. 52.6%; p=0.043). The Bland-Altman plot analysis showed a higher bias in Group B than in Group A (-0.27 [-1.40 to 0.86] vs. −0.01 [-1.42 to 1.39]). In the multivariable logistic regression analysis, the only independent predictor of GU was the use of TRUS SRB (2.64 [1.11 – 6.28]; p=0.024). Conclusions: US-MRI FB appears to be related to a decrease in GU rate and an increase in concordance between biopsy and final pathology compared to TRUS SRB, suggesting that performing US-MRI FB leads to greater accuracy of diagnosis and better treatment decisions.

Resumo Objetivo: Descrever a técnica de injeção de matrizes hemostáticas e a experiência do nosso serviço de radiologia intervencionista na sua aplicação. Materiais e Métodos: Foi realizado estudo unicêntrico com análise retrospectiva da experiência do nosso grupo na utilização de matriz hemostática gelatinosa em biópsias percutâneas. Resultados: Foram realizadas 73 biópsias com utilização de matriz hemostática gelatinosa no trajeto da agulha coaxial em diferentes órgãos, como fígado, rim, baço, entre outros. A única complicação observada foi a migração da matriz hemostática para o sistema coletor do rim esquerdo, sendo solucionada com tratamento clínico. Não foram observados casos de sangramento no trajeto das biópsias após a injeção de matrizes hemostáticas. Conclusão: O uso de matrizes hemostáticas no trajeto de biópsias percutâneas é mais uma ferramenta disponível a ser considerada nos procedimentos minimamente invasivos.

Abstract Objective: To describe the technique of injecting hemostatic matrix, as well as the experience of our interventional radiology department in its application. Materials and Methods: We conducted a single-center study with retrospective analysis of the experience of our group in the use of hemostatic gelatin matrix in percutaneous biopsies. Results: In a total of 73 biopsies in different organs, such as the liver, kidney, and spleen, hemostatic gelatin matrix was introduced into the coaxial needle. The only complication observed was migration of the hemostatic matrix to the left kidney collecting system, and that was resolved with clinical treatment. There were no cases of bleeding after the injection of hemostatic matrix. Conclusion: The use of hemostatic matrices in the path of percutaneous biopsies is another tool available for consideration in minimally invasive procedures.