Safety and efficacy of microwave ablation versus argon-helium cryoablation for the treatment of primary high-risk pulmonary nodules: a propensity score-matched study.

BACKGROUND

Although microwave ablation (MWA) and cryoablation (CA) have shown promising clinical potential in treating pulmonary nodules, a direct comparative study of these two techniques for primary high-risk pulmonary nodules is still lacking. Therefore, this study aims to compare the safety and efficacy of MWA versus CA in patients with primary high-risk pulmonary nodules.

METHODS

This retrospective study analyzed 139 patients treated with either CA (n=31) or MWA (n=108) for 162 nodules between January 2019 and December 2023. Propensity score matching (PSM) was performed based on age, gender, and Charlson Comorbidity Index at a 1:2 ratio, resulting in 95 patients with 114 nodules. Outcomes evaluated included technical success, disease-free survival (DFS), overall survival (OS), and post-procedural complications. All procedures were computed tomography (CT)-guided, with follow-up CT scans at 1, 3, and 6 months, then every 6 months.

RESULTS

Both CA and MWA achieved 100% technical success. The median follow-up was 25 months. Local disease progression rates before matching were 11.43% (CA) and 6.30% (MWA), and after PSM, 12.12% and 7.41%, respectively, with no significant difference. All patients survived at the last follow-up. Post-PSM complication rates were similar (79.31% CA vs. 72.73% MWA), with pneumothorax as the most common. The CA group reported significantly lower pain scores compared to MWA (median 1.00 vs. 2.00, P<0.001). One pulmonary embolism occurred in the MWA group.

CONCLUSIONS

MWA and CA are comparably safe and effective minimally invasive alternatives for treating high-risk pulmonary nodules in patients unsuitable for surgery, with CA showing the advantage of reduced procedural pain.