Interventional radiology in lung cancer: from diagnosis to treatment

Interventional radiology has made great progress during the past decade. In thoracic oncology image guided, percutaneous procedures may be divided into two groups: diagnostic and therapeutic. The routinely perfomed diagnostic procedures include percutaneous biopsy of parenchymal and mediastinal lesions under fluoroscopic or CT guidance. The therapeutic procedures are mainly concerned with the relief of pain. Percutaneous injection of alcohol into bone metastases was one of the first techniques used. Percutaneous vertebroplasty by injection of acrylic cement into lytic lesions of the vertebral bodies is one of the most successful techniques in interventional radiology. Acrylic cement can also be injected into other flat bones such as the acetabulum. Finally, percutaneous tumour ablation by radiofrequency or cryotherapy represents a major advance in interventional oncology. In fact thermo-ablation of tumours has advantages over alcohol injection with better delimitation of the ablation without risk of leakage. It can be performed on different organs for palliation or cure. For pain relief, bone and other metastases can be treated with radiofrequency or cryo-ablation with excellent results. Lung tumours less than 5 cm in diameter can be treated with radiofrequency ablation if surgery is contra-indicated. Similarly, up to 5 lung metastases can be treated by either radiofrequency or cryo-ablation.