Cryoablation systems
Killing a tumour by freezing it through one or more needles, with the ice ball watched live on CT, ultrasound or MRI. It hurts less than heat, spares nearby nerves and collecting systems better, and is the usual choice for small kidney tumours, painful bone metastases and, in trials, small breast cancers.
Overview
Cryoablation probes circulate argon (cooling by the Joule-Thomson effect) or liquid nitrogen to the tip so that an ice ball forms in the tissue; cells die from ice crystal damage, dehydration and vascular injury, and a second freeze after a thaw makes the kill more complete. The ice ball is visible on CT, ultrasound and MRI, so the operator sees exactly what will be destroyed, and several probes can be combined to sculpt the zone. It is standard for small renal masses in patients unsuited to surgery, is used for painful bone and soft-tissue metastases, desmoid tumours, lung metastases, salvage of prostate cancer after radiotherapy and, following the ICE3 single-arm trial, for small low-risk breast cancers in older women. Boston Scientific (Visual-ICE and ICEfx, from Galil Medical), Varian (Endocare) and IceCure (ProSense, liquid nitrogen) are the main vendors.
Compared with radiofrequency and microwave ablation, freezing is less painful, gives a visible margin and is gentler on collecting systems, ureters and nerves, but it is slower, needs more probes for a given volume, carries a bleeding risk because vessels are not coagulated, and can cause cryoshock after very large treatments.
- RF / microwave probe
- Tumour
- Ablation zone > 60 °C (+ margin)
How it works
Argon or liquid nitrogen at the probe tip freezes tissue in an ice ball visible on CT, ultrasound or MRI; intracellular ice, osmotic injury and microvascular thrombosis after a freeze-thaw-freeze cycle destroy the tumour.
- Ice ball visible during treatment
- Less pain and better nerve and collecting-system sparing than heat
- Repeatable, outpatient
- Slower and more probes than microwave
- Bleeding risk because vessels are not sealed
- Size limits and cryoshock after large volumes
Latest papers
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