Ultrasound-Guided 3D Tumor Model Fusion Pipeline for Renal Mass Ablation: Insights and Outcomes

In the evolving landscape of renal mass ablation (RMA), the integration of technology has significantly improved procedural efficacy and safety. This study outlines the development and implementation of a 3D tumor modeling and fusion radiomics pipeline at our institution, utilizing publicly available software to enhance RMA procedures. While prostate biopsies have benefited from MRI-Ultrasound fusion techniques, RMA has traditionally relied on cognitive approaches without pre-treatment modeling. Our pipeline employs 3D Slicer, an open-source radiomics program that facilitates tumor segmentation and modeling. Semi-automatically generated 3D models from patient CT scans enable detailed simulation and planning for probe placement, with safety zones color-coded for optimal ablation effectiveness. Over a five-year period, we retrospectively analyzed 331 RMA cases, revealing an average lesion size of 24 mm. The majority of tumors were located in the upper pole, with 92.1% of patients undergoing microwave ablation. Concurrent biopsies were performed in 76.6% of cases, predominantly identifying renal cell carcinoma. We noted a complication rate of 1.8%, with six patients experiencing Grade 3a complications. At a median follow-up of 2.1 years, tumor recurrence occurred in 6.6% of cases, while 2% of patients developed metastatic disease. The overall mortality rate was 10%. Our findings suggest that the 3D modeling and real-time fusion pipeline enhances RMA outcomes, offering a promising framework for future advancements in treatment prediction through radiomic features and AI integration.