Interventional radiology at Institut Curie

What is interventional radiology

Although it has been used for many years, interventional radiology is still quite unknown to patients. It is a radiological subspecialty that includes all procedures guided by medical imaging techniques and aimed at diagnosing or treating a wide variety of conditions. 

Specifically, it involves multiple procedures performed with medical devices introduced into the patient's body, either through the skin, or through the blood vessels (arteries or veins), with the placement of the material being precisely controlled thanks to one or more imaging techniques. 

There are various guidance techniques that interventional radiologists use - they can be techniques involving X-rays (radioscopy, CT scan), as well as ultrasound, or even MRI. 

In oncology, this constantly evolving discipline is used in two situations - either for diagnostic purposes (removing tumors), or for therapeutic purposes (treating patients).

Diagnostic interventional radiology

In oncology, the purpose of diagnostic interventional radiology is to remove tumors. These percutaneous needle sampling techniques, guided by imaging, make it possible to avoid a surgical procedure, which would be more invasive. These samples of cancerous tissues make it possible to carry out a histological and biological analysis in order to precisely characterize the tumor and in some cases to identify molecular abnormalities that may constitute therapeutic targets. 

It is thus possible to perform biopsies of superficial soft tissues, such as in the breast, or the muscles, but also in deep organs such as the liver, the lungs, and even in the bone, with adapted equipment. The guidance techniques vary depending on the organ to be biopsied and on the visibility of the lesion. Thus, to take a sample from the breast, the needle will be guided either by an ultrasound, by a mammogram, or by an MRI; for the lung, guidance most often requires the use of a scanner; for the abdominal organs, ultrasound or scanner can be used depending on the area to be sampled. The approach is thus adapted to each anatomical region. 

Every year, the radiologists of Institut Curie perform about 5,000 biopsies, including more than 3,000 for breast tumors. This activity also requires great expertise from the pathologists and biologists who analyze the samples and who must arrive at a diagnosis using small samples.

Therapeutic interventional radiology

Here, the objective is to treat the patient while directly destroying the tumor with the help of needles placed through the skin and into the lesion. The most used techniques are the so-called ablathermy methods, where the tumor is destroyed by heating (radiofrequency techniques, microwaves) or by cooling (cryotherapy). Institut Curie is authorized to perform these interventions under local or general anesthesia, depending on the case. 

Interventional radiology can also be used to treat complications related to cancers or metastases. For example, bone metastases of cancers can benefit from treatments to consolidate the bone, such as cement injection (cementoplasty, vertebroplasty) or the placement of screws percutaneously (osteosynthesis), without the need for major orthopedic surgery, or in addition to it. These techniques are used either curatively - in which case they greatly alleviate the pain and improve the autonomy of the patients - or preventively when the imaging detects a "risk" lesion on the spine or a "carrier" bone (pelvic bone or leg).

Various interventional radiology procedures at Institut Curie

Interventional radiology practices vary depending on the type of cancer and affected organs.

Some procedures are quite superficial and very minimally invasive, and are therefore performed externally; patients leave after their procedure, without hospitalization. These include, for example, samples from the thyroid taken with very fine needles or biopsies from superficial soft tissues (for the diagnosis of sarcoma).

Other, more risky procedures are carried out in a day hospital, in an outpatient surgery unit, with patients being monitored by nurses a few hours after the procedure.

For heavier interventions, or higher-risk actions such as liver or lung biopsies in fragile patients, a 24-hour period of hospitalization is often required. This is also the case for therapeutic interventional radiology procedures such as vertebroplasties. Such patients are monitored at the hospital for 24 hours. This procedure is arranged in a manner quite comparable to surgery, with interventional radiologists taking care of patients in a consultation setting before, during their hospitalization, and then after the procedure has been performed.

Institut Curie's expertise in interventional senology

The Paris and Saint-Cloud sites of Institut Curie both have a specialized platform for diagnostic and interventional senology. Each site is equipped with a technical platform that allows for breast biopsies and lymph node sampling guided by the latest generation equipment - ultrasound, stereotaxis table, tomosynthesis, angiomammography, and MRI.

Interventional radiology for children

For children and adolescents, interventional oncology radiology procedures are performed in a safe and soothing setting that allows for optimal management at the Paris site of Institut Curie with its expert team of radiopediatricians. These procedures are performed under local anesthesia or in the operating room under general anesthesia depending on the age of the patients and location of the tumors.

Interventional radiology under general anesthesia

At the Paris site of Institut Curie, there is a dedicated interventional radiology room within the operating theater. This room, equipped with a mobile scanner, a brightness amplifier and an ultrasound machine, makes it possible to perform procedures under local anesthesia or under general anesthesia when such procedures are particularly painful or long. Just like in the case of surgery, the collaboration of radiologists with the anesthesia teams is then essential. Institut Curie and a few other hospitals specialize in the above.

The possibility of combining interventional radiology with surgery at Institut Curie

The Institut Curie's operating theater allows for combined surgery and interventional radiology procedures. The surgeon and the interventional radiologist can work together on the patient in the same room, for example, to treat liver metastases, while administering anesthesia only once and as part of the same operative procedure. The surgeon is responsible for the resection of part of the liver, and the radiologist - for the elimination of other metastases using radiofrequency in order to preserve the affected organ as much as possible.

Advantages of interventional radiology

Above all, the goal of interventional radiology is to be very minimally invasive and to avoid more extensive surgical procedures. A few millimeters are indeed enough to pass a needle through the skin and guide the procedure by imaging to the target.

Interventional radiology is particularly useful in the context of rapid diagnostic circuits intended for patients whose disease has not yet been identified. On the same site, the patient can be examined by a doctor or surgeon and can undergo medical imaging; after that the radiologist can complete the imaging and decide to perform a biopsy, either immediately or in the following days. Thus, the cytological, histological, and biological results are obtained very quickly.

Interventional radiology research

Institut Curie is currently working on researching the use of cryotherapy to treat certain breast cancers as an alternative to surgery. Currently, this technique is mainly aimed at women with small localized cancers that are not aggressive and at those with an operative contraindication (or those refusing surgery). Recent studies demonstrate that this technique is very effective. It is anticipated that it could be applied in other cases in the future. It is also being evaluated for other tumors such as desmoid tumors (rare tumors developing in the muscles).

In diagnostic interventional radiology, Institut Curie has also developed a technique for biopsy of the uterus, allowing the teams of anatomopathology and somatic genetics to diagnose certain rare tumors of the uterus (sarcomas). The surgical technique can thus be optimized (in the case of sarcoma) or, on the contrary, when the analysis is reassuring, the fertility of women can be preserved.

Medical team

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