An audit of percutaneous lung tumour radiofrequency ablation

Radiofrequency ablation (RFA) is being used as a local treatment method for lung, liver and renal tumours. This is a relatively new technique. Current NICE recommendation suggests that treatments should be undertaken in the context of frequent audit.

RFA uses heat to locally destroy tumour tissue. The lung is a common treatment site. More regional centres are developing a service and careful audit of success and complications is required.

The standard: 

Clerical and secretarial support-to organise patient bookings and lists

Dedicated radiology nursing cover-to provide assistance during the procedure, aftercare and discharge

Dedicated radiographer cover-senior radiographers familiar with RFA and interventional CT

At least two consultant radiologists trained in RFA technique

Outpatient facilities-for preclerking and post procedural review

Anaesthetic availability-for administration of general anaesthesia when required

Access to day case beds-patients admitted under joint careComplication rates should be low and within published standards:

• Minor complications- small pneumothorax, mild chest pain, mild haemoptysis, mild pyrexia
• Major complications - pneumothorax requring drainage, abscess, severe chest pain, severe haemoptysis, deathLocal relapse rate at 1,2 and 3 years.

Target: 

100% compliance with the above staffing and logistical targets (Ref 1).

Complications: minor <27%, major <6% (Ref 2,).

Local relapse rate: <30% at three years (Ref 3).

Indicators: 

Data items to be collected: 

Patient demographics; Treatment dates; Treatment details (electrode used, ablation cycles)

Immediate complications as seen on CT / clinically

Findings on follow up CT (performed at 1,3,6,9,12,15,18,21,24,27,30,33 and 36 months)

Case notes review.

Suggested number: 

All patients undergoing lung RFA for primary or secondary pulmonary malignancy. Ideally with follow up for three years for local relapse component of audit. Typical number=30

Review staffing and logistic support.

Observe for patterns in complications or local relapse rate. Are the correct lesions being treated?

PACS and RIS access

Local RFA database

Case note/electronic record review

Approximately 5 hours of work to review caseload if prospective database is kept

1. Standards for radiofrequency ablation (RFA), Second Edition RCR, 2013.

2. Li, G., Xue, M., Chen, W. and Yi, S. (2018). Efficacy and Safety of Radiofrequency Ablation for Lung Cancers: A Systematic Review and Meta-Analysis. European Journal of Radiology.

3. RAPTURE. Lancet Oncology, Vol 9, 2008

4. Bolland et al, Radiology 254 (1) Jan 2010.

Dr S Smith and Dr P Jennings. Updated by H Bailey 2018