Synchronous percutaneous microwave ablation combined with percutaneous biopsy for highly suspected malignant pulmonary nodules: a retrospective study.

Background: There is still a lack of studies on the optimal sequence of treatment for microwave ablation (MWA) combined with percutaneous biopsy (PB) in the treatment of highly suspected malignant pulmonary nodules (PNs). This study aimed to investigate the feasibility, safety, and efficacy of computed tomography (CT)-guided simultaneous MWA combined with PB in the treatment of highly suspected malignant PNs and discuss the influence of the sequential order of MWA and PB on the treatment outcome.

Methods: From January 2021 to December 2024, 91 patients with single highly suspected malignant PNs underwent synchronous MWA combined with PB. A total of 56 patients in group A underwent synchronous MWA followed by PB (MWA-first group) and 35 cases in group B underwent synchronous PB followed by MWA (PB-first group). The technical success, pathologically positive diagnosis rate, complications, and efficacy of the two groups were compared.

Results: The differences in technical success rate (100% 97.1%) and positive pathologic diagnosis rate (80.4% 88.6%) between group A and group B were not statistically significant (P>0.05). The most common complications included pneumothorax, intrapulmonary hemorrhage, hemoptysis, and pleural effusion. The incidence of intrapulmonary hemorrhage was significantly lower in group A than in group B (19.6% 42.8%, P<0.05). The median follow-up time was 18.0 months, the local control rate was 98.8%, and the complete ablation (CA) rate was 56.6%.

Conclusions: Synchronous MWA combined with PB is a safe and effective strategy. MWA followed by PB could reduce the impact of intrapulmonary hemorrhage on ablation outcomes and is an alternative treatment for highly suspected malignant PN.