Association between Three-dimensional Margin Assessment and Local Tumor Control in Percutaneous Lung Cryoablation of Colorectal Metastases

Authors

Frank Mohn
Koustav Pal
Caleb O'Connor
Iwan Paolucci
Austin Castelo
Kamran Ahrar
Steven Yevich
Joshua D Kuban
Bruno C Odisio
Alda Lui Tam
Rahul A Sheth
Kristy K Brock

Language

English

Publication Date

1-1-2026

Journal

Radiology: Imaging Cancer

DOI

10.1148/rycan.250113

PMID

41481489

PMCID

PMC12865602

PubMedCentral® Posted Date

1-2-2026

PubMedCentral® Full Text Version

Post-print

Abstract

Purpose

To evaluate the association of two minimum ablation margin (MAM) estimation methods: manual three-dimensional segmentation and biomechanical deformable image registration (DIR) with local tumor progression-free survival (LTPFS) after percutaneous lung cryoablation of colorectal pulmonary metastases.

Materials and Methods

This retrospective single-institution study included patients who underwent percutaneous lung cryoablation between May 2012 and March 2023 (median follow-up, 3.6 years; range, 0.8–9.6 years). Manual three-dimensional MAM was calculated for all tumors, and DIR-based MAM was estimated in a subset with intraprocedural full-thorax imaging. Cox proportional hazards regression assessed associations between MAM and LTPFS. The primary outcome was 2-year LTPFS, with a secondary outcome of whether DIR-based MAM was associated with LTPFS.

Results

Thirty-eight patients (76 colorectal pulmonary metastases in 63 procedures; mean age, 58 years ± 12 [SD]; 19 female patients) were included. Technical success was 100% (63 of 63). Per-lesion LTPFS at 1 and 2 years was 87% and 84%. Five tumors (6.6%; five of 76) had no margin (0 mm), 55 tumors (72%; 55 of 76) had a MAM 0–5 mm, and 16 (21%; 16 of 76) had an MAM greater than 5 mm. Median LTPFS was 6 months for the 0-mm group and was not reached for the MAM 0–5-mm and the greater than 5-mm groups (P < .001). Receiver operating characteristic analysis for 2-year local progression yielded an area under the receiver operating characteristic curve (AUC) of 0.81 (95% CI: 0.62, 0.95). Among 36 tumors (22 patients) with full-lung imaging available, the DIR-based MAM had an AUC of 0.76 (95% CI: 0.55, 0.98), and the manual method had an AUC of 0.79 (95% CI: 0.52, 1.00). At multivariable analysis, MAM greater than 0–5 mm (hazard ratio [HR], 0.05; P < .001), MAM greater than 5 mm (hazard ratio, 0.03; P = .005), and ablation volume (hazard ratio, 0.93; P < .001) were independently associated with reduced LTP.

Conclusion

Quantitative MAMs are strongly associated with LTPFS, underscoring the importance of achieving adequate margins in percutaneous lung cryoablation.

Keywords

Humans, Female, Middle Aged, Male, Cryosurgery, Lung Neoplasms, Colorectal Neoplasms, Retrospective Studies, Aged, Imaging, Three-Dimensional, Margins of Excision, Tomography, X-Ray Computed, Adult, Pulmonary Cryoablation, Deformable Image Registration, Colorectal Cancer, Pulmonary Metastasis, Minimum Ablation Margin

Published Open-Access

yes

Recommended Citation

Mohn, Frank; Pal, Koustav; O'Connor, Caleb; et al., "Association between Three-dimensional Margin Assessment and Local Tumor Control in Percutaneous Lung Cryoablation of Colorectal Metastases" (2026). Faculty, Staff and Student Publications. 5375.
https://digitalcommons.library.tmc.edu/uthgsbs_docs/5375