Optical coherence tomography (OCT) and irreversible electroporation (IRE) in the diagnosis and treatment of renal masses Towards a minimally invasive approach

The first aim of this thesis is to investigate the diagnostic value of needle-based, percutaneous optical coherence tomography (OCT) in the differentiation of renal masses. Secondly, the feasibility and safety of percutaneous, irreversible electroporation (IRE) are assessed for the treatment of SRMs.
Chapter 2 reports on the comparison between OCT and conventional RMB for the differentiation of renal masses. Diagnostic yield (total percentage of biopsies that lead to diagnosis) and accuracy, (sensitivity, specificity, negative predictive value, and positive predictive value) will be assessed for both OCT and RMB in a prospective cohort of 95 patients. In chapter 3 a literature overview is presented of the novel ablative technologies, including irreversible electroporation (IRE), microwave ablation (MWA), and stereotactic ablative radiation therapy (SABR), for the treatment of localised RCC. They are compared to the currently established ablative techniques, cryoablation and radiofrequency ablation (RFA). In chapter 4 a literature overview on IRE in several organs is provided including the liver, pancreas, kidney, and prostate. Additionally, the principle and the procedure of IRE is described. Chapter 5 reports on the study protocol regarding IRE for the ablation of localised RCC in humans. It aims at feasibility and safety, functional outcomes, and clinical efficacy. Additionally, the protocol has a specific focus on several imaging techniques (MRI, CT, and contrast-enhanced ultrasound) used in the follow-up after IRE. Chapter 6 reports on the feasibility and safety results of the IRE study, as well as the functional outcomes including postoperative pain and renal function. Chapter 7 describes the imaging characteristics, enhancement, and the volume of the ablated tumour after renal IRE ablation using contrast-enhanced CT and MRI.