A 79-year-old otherwise healthy male with no previous comorbidities (ECOG 0), presented with a lesion in the kidney measuring just under 6cm. Both the MDT and the patient preferred cryoablation with CAS-One IR over partial nephrectomy. At the time of treatment the tumor had grown to 6.5cm. Five cryoablation needles were planned and inserted with CAS-One IR which then enabled a complex hydrodissection protecting the spleen, colon, and ureter. Significant organ movement occurred between the first and last scan, however, automatic fusion enabled an accurate ablation confirmation. The patient was discharged the next day.
Planning of the five needle trajectories with AI segmentation of the lesion including a 5mm margin
3D visualization of the six needles and a needle-eye view.
Needle placement of the final cryoablation probe. An additional needle was placed freehand to obtain the remaining coverage of the tumor.
Automatic fusion with AblaFuse was able to instantly correct the movement between first and final scans to confidently assess the final margins
The ablation zone is minorly undersegmented, however AblaSure reveals the potential missed margins, thus making them easier for visual assessment. Segmentation for 6cm+ kidney tumors will improve with the next release of CAS-One IR software, a initial atasets were limited.
Manual ablation zone coverage to supplement the automatic segmentation
Name: Dr. Michael Deutschmann , Prim. Kaveh Akbari, Prim. Christian Neumann (Barmherzige Brüder Wien)
Institution: Salzkammergrut Klinikum Vöcklabruck
Patient age and sex: Male, 79-years-old
Initial condition and Imaging:
- ECOG 0 patient with no comorbitites
- Initial diagnosis January 2026
- Lesion measuring 4,2x5,6 discovered on a CT scan. Now showing biggest diameter of 6,5cm
- Partial nephrectomy was discussed as an alternative treatment but the MDT unanimously agreed cryoablation was preferred.
Treatment:
- The procedure was performed with under general anasthesia and complete neuromuscular paralyis to avoid any muscular movement during the case
- Cryoablation was performed with the Boston Scientic probes, using a total of six (mix of IceForce and IcePearl)
- All three lesions were planned on the initial pre-ablation scan. After each ablation, the ablation zones were assessed using AblaSure®
- The five first needles was accuratley places with a displacement of less than 2mm
- A hydrodissection with pressure flushing was perfromed to ensure that there was no damage to risk organs nearby (spleen, colon and ureter)
- After the five needles was succsesfully placed with CAS-One IR, a sixth needle was placed freehand to cover the last part of the lesion
Result and Conclusion
- AblaSure performed well but was undersegmented to the actual ablation zone. This was likely due to the abnormally large tumor size, as well as the reduction in iceball size during the time from needle extraction, to CT scan.
- The physician used the manual AblaSure sphere representation to augment the automatic AblaSure segmentation to visually assess that 100% tumor and margins had been met.
- The patient was discharged the next day
- 9 days after the ablation, a macrohematuria was discovered and treated with microcoil embolization
- Route follow ups are planned at 3 month intervals.
Dr. Deutschmann said of the case "This was a remarkable outcome for the patient. Without CAS-One IR, a partial nephrectomy would have been the likely choice from the MDT. The planning capabilites of CAS-One IR for such a large tumor reduce the total procedure time, as well as raise confidence that our strategy is correct, especially with hydrodissection. The new automatic fusion capabilities are also very impressive.