Efficacy and safety of percutaneous thermal ablation in Bosniak III and IV cystic renal masses: a systematic review and meta-analysis.

Purpose: Local thermal ablation is considered a standard treatment for small kidney masses. However, few studies have investigated the efficacy and safety of thermal ablation for cystic kidney masses.

Methods: The MEDLINE library, Cochrane, and SCOPUS databases were screened for studies investigating the efficacy of thermal ablation for cystic renal masses, comprising studies between 1995 and February 2024. In total, seven studies were deemed suitable and included in the present analysis.

Results: The studies included a total of 113 participants with 134 cystic renal masses. The sample sizes ranged from 5 to 38 participants. There were 76 men (67.2%) and 37 women (32.8%), with a mean age of 64.7 years (range: 50 to 75.4 years). Overall, 55 cystic masses were classified as Bosniak III (41%) and 79 as Bosniak IV (59%). Technical success of local thermal ablation was reported in 133 cystic masses (99.2%). The pooled meta-analytic technical success rate was 100% [95% confidence interval (CI): 96%-100%, I² = 0.0%]. Complications were reported in 9 cases (6.7%). According to the Society of Interventional Radiology classification system, there were 3 major complications (2.6%) and 6 minor complications (5.3%). The pooled meta-analytic complication rate was 10% (95% CI: 5%-20%, I² = 40%). No tumor recurrence was reported during follow-up.

Conclusion: Local thermal ablation can be considered a highly effective and safe procedure for cystic kidney masses. Most studies were performed using radiofrequency ablation, underscoring the need for further studies on alternative ablation techniques such as microwave ablation and cryoablation.

Clinical significance: Local thermal ablation is an effective and safe procedure for treating cystic kidney masses.