Radiofrequency and microwave ablation of subcapsular hepatocellular carcinoma accessed by direct puncture: Safety and efficacy. Issue 4 (April 2016)

• Record Type: Journal Article
• Authors: Francica, Giampiero; Meloni, Maria Franca; de Sio, Ilario; Smolock, Amanda R.; Brace, Christopher L.; Iadevaia, Maddalena Diana; Santambrogio, Roberto; Sironi, Sandro; Scaglione, Mariano; Lee Jr., Fred T.
• Is Part Of: European journal of radiology. Volume 85:Issue 4(2016)
• Page Start: 739
• Page End: 743
• Publication Date: 2016-04
• Subjects: Ultrasound -- Thermal ablation -- Hepatocellular carcinoma -- Seeding; Medical radiology -- Periodicals; Radiology -- Periodicals; Radiologie médicale -- Périodiques; Medical radiology; Periodicals; 616.075705
• DOI: 10.1016/j.ejrad.2016.01.020
• Languages: English
• ISSNs: 0720-048X

Abstract

Highlights: Conventional teaching has dictated that thermal ablation of subcapsular HCC tumors be approached with caution and if accessed percutaneously the therapeutic needles should traverse a tract of normal hepatic parenchyma in order to avoid complications such as hemorrhage and tumor seeding. Our study of 67 subcapsular tumors in 60 patients ablated through direct puncture access challenges this notion since we found no significant increase in complications, including hemorrhage and tumor seeding. Our only case of tumor seeding was in a patient who had also undergone a percutaneous biopsy of the tumor through the same tract for access, suggesting that the biopsy, and not the ablation, could account for the tumor seeding. Our experience demonstrates that direct puncture of subcapsular tumors is both safe and effective. Abstract: Objectives: Direct puncture of subcapsular hepatocellular carcinoma (HCC) for tumor ablation has been considered high risk due to a perceived increased incidence of hemorrhage or tumor seeding. The purpose of this retrospective multicenter study was to identify the rate of tumor seeding, hemorrhage and local tumor progression (LTP) associated with direct puncture radiofrequency (RF) and microwave (MW) ablation of subcapsular HCC. Methods: A multicenter, retrospective review of direct-puncture RF and MW performed on subcapsular HCC was conducted. Complications and local tumor progression were documented. Data was analyzed using Kaplan–Meier and log-rank tests. Results: The study group consisted of 60 cirrhotic patients (M/F = 43/17; mean age 69.6 years) with 67 subcapsular HCC (mean diameter 2.3 cm ± 1.0 cm) that were directly punctured for RF ( n = 40) or MW ( n = 27) under ultrasound (US) guidance. The mean follow-up period was 30.8 months. There were no hemorrhagic complications. The overall LTP rate was 13.4%. There was one case of tumor tract seeding in a patient who had undergone a percutaneous biopsy two weeks prior to RF. Conclusions: Thermal ablation of HCC by direct puncture appears safe and effective. There were no cases of intraperitoneal hemorrhage, and tumor seeding was seen in a single case in which a preceding percutaneous biopsy had been performed.