Superior Performance of Synchronized Percutaneous Microwave Ablation and Immediate Percutaneous Biopsy for Highly Suspected Malignant Pulmonary Ground-Glass Nodules

Objective: In recent years, experience has been accumulated in microwave ablation (MWA) of ground-glass nodules (GGNs). The goal of this retrospective study was to explore the feasibility, safety, and efficacy of synchronized computed tomography (CT)-guided MWA combined with intraoperative percutaneous biopsy (PB) for the treatment of highly suspected malignant GGNs. Methods: From January 2021 to February 2025, 93 patients with highly suspected malignant GGNs underwent MWA and PB. Forty-one patients in group A were treated with sequential low power MWA-PB-radical MWA in one session. Fifty-two patients in group B were treated with staged procedures. The pathologic diagnostic results and pathology positive diagnosis rate were evaluated. The technical success, complete ablation rate, and complications were analyzed. The total operative time, irradiation dose, hospitalization time, and hospitalization expenses were compared between the 2 groups. Results: The technical success rate of both groups was 100%. The complete ablation rates of group A and group B were 100% and 98.1%, respectively ( P >0.05). The positive pathologic diagnosis rate of group A was 90.2% (37/41). The incidence of pneumothorax and intrapulmonary hemorrhage was lower in group A than in group B (29.3% vs. 50.0%, P =0.04; 17.1% vs. 61.5%, P <0.001). The total operative time, irradiation dose, hospitalization time, and hospitalization expenses were lower in group A than in group B (all P <0.001). Conclusion: Synchronized MWA and intraoperative PB is a safe and effective strategy with satisfactory technical success, complete ablation rates, and acceptable rates of positive pathologic diagnosis, which is an alternative treatment for GGNs with high suspicion of malignancy.