Image-guided percutaneous ablation techniques for the treatment of renal cell carcinoma: a primer for radiologists

Percutaneous renal tumor ablation (RTA) has become an established treatment option for selected patients with small renal masses, particularly cT1a tumors in patients with relevant comorbidity, hereditary renal tumor syndromes, impaired renal function, or a solitary kidney. In this review, we summarize current indications for RTA, the main ablation technologies, image-guidance strategies, preprocedural planning, adjunctive techniques, intraprocedural considerations, complications, and post-ablation follow-up. We also review current evidence comparing RTA with partial nephrectomy, with particular attention to oncologic outcomes, renal function preservation, and morbidity. Although guideline recommendations remain relatively conservative, accumulating evidence supports percutaneous ablation as an important nephron-sparing treatment option in appropriately selected patients. This review aims to provide radiologists with a practical overview of contemporary renal tumor ablation and its role in the multidisciplinary management of renal cell carcinoma.