Fig. 4

 A typical case of NSCLC treated with coaxial MWA and pre- and post-ablation CNB. (a) A NSCLC patient has a new solid lesion (white arrow) and moderate pleural effusion (black arrow) in the left lung, with a treatment history of bilateral segmentectomy and the pathological diagnosis of adenocarcinoma. (b) CT-guided coaxial MWA and CNB were undergone, with the pre-ablation CNB being performed for the pathological diagnosis and genomic testing. (c) MWA was performed, with 30 W of energy released and seven minutes of ablation time. (d) Post-ablation CNB was undergone in the same site as the pre-ablation CNB, and the specimens were also used for pathological diagnosis and genomic testing. (e) The chest tube was inserted to drain the pleural effusion (black arrow), with the finding of adenocarcinoma cells in pleural effusion. (f) The 24 h CT reexamination reveals the ablation zone and the reduction of malignant pleural effusion. (g) The specimens obtained from pre-ablation CNB confirmed the diagnosis of adenocarcinoma and the gene mutation of BRAF V600E. The H&E stain showed that the tumor was adenoidal, with a clear adenoidal structure, round and ovoid nuclei, uniform chromatin, clear cell boundaries, and interstitial fibrosis. The DNA and RNA extracted from specimens were 84.9 and 19.3 ng/µl, respectively. (h) The specimens obtained from post-ablation CNB confirmed the diagnosis of adenocarcinoma and the gene mutation of BRAF V600E. The H&E stain showed that the tumor was adenoidal with deformation, sharp margins, nuclei with elevated flow-like changes, deep chromatin staining, unclear cell boundaries, and obvious signs of interstitial cauterization. The DNA and RNA extracted from specimens were 20.0 and 4.5 ng/µl, respectively, with a significant decrease from that of pre-ablation CNB.