{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T12:23:11Z","timestamp":1784204591384,"version":"3.55.0"},"reference-count":101,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T00:00:00Z","timestamp":1740700800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Percutaneous image-guided ablation (IGA) has emerged as an established alternative to surgical management for small renal masses. This comprehensive review examines traditional and emerging indications, energy sources, techniques, and future developments in IGA for renal cancer treatment. Traditionally, IGA has been indicated for frail or comorbid patients, those with solitary kidneys or chronic kidney disease, and those with histologically proven renal cell carcinomas less than 4 cm in size. Recent evidence supports expanding these indications to include T1b or T2 tumours and hereditary or recurrent renal cell carcinomas. The use of IGA combined with pre-ablation transarterial embolisation is discussed herein. This review then explores traditional energy sources including radiofrequency ablation, cryoablation, and microwave ablation, highlighting their respective advantages and limitations. Emerging technologies such as irreversible electroporation and histotripsy, as promising alternatives, are then presented, highlighting their advantage of being able to treat tumours near critical structures. Future research priorities highlight the need to establish high-quality evidence through innovative trial designs, as well as taking patient-reported outcome measures into account. Health economic considerations are key to ensuring that ablation therapies are cost-effective. The integration of artificial intelligence and radiomics shows vast potential for improving patient selection and treatment outcomes. Additionally, the immunomodulatory effects of ablative therapies suggest possible synergistic benefits when combined with immunotherapy which also require exploration in future research. Technological advancement and research developments will continue to broaden the role of IGA in clinical practice.<\/jats:p>","DOI":"10.3390\/medicina61030438","type":"journal-article","created":{"date-parts":[[2025,2,28]],"date-time":"2025-02-28T10:46:46Z","timestamp":1740739606000},"page":"438","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Percutaneous Image-Guided Ablation of Renal Cancer: Traditional and Emerging Indications, Energy Sources, Techniques, and Future Developments"],"prefix":"10.3390","volume":"61","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6108-9315","authenticated-orcid":false,"given":"Vinson Wai-Shun","family":"Chan","sequence":"first","affiliation":[{"name":"Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK"},{"name":"Division of Diagnostic and Interventional Radiology, Institute of Oncology, St James\u2019s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helen Hoi-Lam","family":"Ng","sequence":"additional","affiliation":[{"name":"Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK"},{"name":"Division of Diagnostic and Interventional Radiology, Institute of Oncology, St James\u2019s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khalil","family":"Abdulrauf","sequence":"additional","affiliation":[{"name":"Pennine Care NHS Foundation Trust, Manchester OL6 7SR, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hira","family":"Zaman","sequence":"additional","affiliation":[{"name":"School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aisha","family":"Ahmed","sequence":"additional","affiliation":[{"name":"School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5325-3739","authenticated-orcid":false,"given":"Jim","family":"Zhong","sequence":"additional","affiliation":[{"name":"Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK"},{"name":"Division of Diagnostic and Interventional Radiology, Institute of Oncology, St James\u2019s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5670-5454","authenticated-orcid":false,"given":"Tze Min","family":"Wah","sequence":"additional","affiliation":[{"name":"Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds LS2 9JT, UK"},{"name":"Division of Diagnostic and Interventional Radiology, Institute of Oncology, St James\u2019s University Hospital, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,2,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.eururo.2022.03.006","article-title":"European Association of Urology Guidelines on Renal Cell Carcinoma: The 2022 Update","volume":"82","author":"Ljungberg","year":"2022","journal-title":"Eur. 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