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Giorgio A, De Luca M, Gatti P, Ciraci' E, Montesarchio L, Santoro B, Di Sarno A, Coppola C, Giorgio V. Treatment of Hydatid Liver Cyst With Double Percutaneous Aspiration and Ethanol Injection Under Ultrasound Guidance: 6.5-Year Median Follow-up Analysis. Cardiovasc Intervent Radiol 2021; 44:1214-1222. [PMID: 33987694 DOI: 10.1007/s00270-021-02839-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/02/2021] [Indexed: 02/07/2023] [Imported: 08/29/2023]
Abstract
PURPOSE Although hydatid liver cyst (HLC) is a benign disease, treatment is recommended to avoid life-threatening complications. There are several treatment options for HLC: "wait-and-watch," medical or surgical or percutaneous treatment. The purpose of this study was to assess the long-term effectiveness of an alternative of the traditional percutaneous PAIR procedure, called double percutaneous aspiration and ethanol injection (D-PAI). MATERIALS AND METHODS This prospective, non-randomized study was conducted from 1988 to 2019 using DPAI procedure characterized by no reaspiration of the ethanol injected to replace the aspirated fluid and repetition of the procedure after 3-7 days. RESULTS Two hundred and three patients with 290 HLCs underwent D-PAI. Two hundred and two HLC (160 patients) were univesicular cysts and 88 (43 patient) were multivesicular. Seventeen patients underwent one D-PAI session, 15 patients two sessions, and 18 up to four sessions. The follow-up ranged 0.9-21 years (median 6.5 years). On ultrasound, 188 cysts (64.8%) disappeared; 57 cysts (19.7%) became solid (inactive) and 45 (15.5%) showed a small inactive residual component. Parasitologic cure was very high. The overall response to D-PAI was higher than 90% considering also the procedures carried out after the first D-PAI at the time of recurrence. One patient died for anaphylactic shock. The hospital stay ranged 1-3 days. Smaller cysts (< 5 cm) healed sooner than larger cysts (p < 0.001). CONCLUSIONS Long-term analysis showed that D-PAI is a safe and effective option in percutaneous treatment of viable HLC, except for CE2/CE3b in which the recurrences can be observed. This inexpensive and simple procedure can be applied everywhere and especially in developing countries.
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Affiliation(s)
- Antonio Giorgio
- Liver Unit and Interventional Ultrasound Unit, Athena Clinical Institute, Piedimonte Matese, Caserta, Italy. .,Abdominal Surgery Unit, Ruesch Clinical Center, Naples, Italy.
| | | | - Pietro Gatti
- Internal Medicine Unit, Brindisi General Hospital, Brindisi, Italy
| | - Emanuela Ciraci'
- Internal Medicine Unit, Brindisi General Hospital, Brindisi, Italy
| | | | - Bruno Santoro
- Liver Unit and Interventional Ultrasound Unit, Athena Clinical Institute, Piedimonte Matese, Caserta, Italy
| | | | - Carmine Coppola
- Internal Medicine and Interventional Hepatology Unit, Gragnano Hospital, Gragnano, Naples, Italy
| | - Valentina Giorgio
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Giorgio A, De Luca M, Gatti P, Giorgio V. Non-enhanced Magnetic Resonance Imaging Compared to Ultrasound as a Surveillance Tool for Hepatocellular Carcinoma. Not all that glitters is gold: the ultrasound hepatologist's point of view. J Ultrasound 2021; 25:129-131. [PMID: 33389594 PMCID: PMC8964864 DOI: 10.1007/s40477-020-00543-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/15/2020] [Indexed: 11/25/2022] [Imported: 08/29/2023] Open
Affiliation(s)
- Antonio Giorgio
- Liver Unit and Interventional Ultrasound Unit, Athena Clinical Institute, Piedimonte Matese (CE), viale Colli Aminei, 491, 80131, Naples, Italy.
| | | | - Pietro Gatti
- Internal Medicine Unit, Brindisi General Hospital, Brindisi, Italy
| | - Valentina Giorgio
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Giorgio A, De Luca M, Gatti P, Matteucci P, Giorgio V. CEUS LI-RADS Categories to Distinguish Hepatocellular Carcinoma and Non-Hepatocellular Carcinoma Malignancies. Radiology 2020; 296:E121-E122. [PMID: 32396043 DOI: 10.1148/radiol.2020200623] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] [Imported: 08/29/2023]
Affiliation(s)
- Antonio Giorgio
- Liver Unit and Interventional Ultrasound Unit, Athena Clinical Institute, Via Matese 90, 81016 Piedimonte Matese (CE), Italy
| | | | - Pietro Gatti
- Internal Medicine Unit, Brindisi General Hospital, Brindisi, Italy
| | - Paolo Matteucci
- Radiation Oncology Unit, Campus Biomedico University, Rome, Italy
| | - Valentina Giorgio
- Department of Woman and Child Health and Public Health, Fondazione Policlinico A. Gemelli IRCSS, Rome, Italy
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Giorgio A, Gatti P, De Luca M, Matteucci P, Giorgio V. Editorial on "Role of thermal ablation in the management of colorectal liver metastasis". Hepatobiliary Surg Nutr 2020; 9:62-64. [PMID: 32142060 PMCID: PMC7026782 DOI: 10.21037/hbsn.2019.10.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 10/21/2019] [Indexed: 08/29/2023] [Imported: 08/29/2023]
Affiliation(s)
- Antonio Giorgio
- Liver Unit and Interventional Ultrasound Unit, Athena Clinical Institute, Piedimonte Matese (CE), Italy
| | - Pietro Gatti
- Internal Medicine Unit, Brindisi General Hospital, Brindisi, Italy
| | | | | | - Valentina Giorgio
- Fondazione Policlinico A. Gemelli IRCCS, Department of Woman and Child Health and Public Health, Roma, Italy
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Giorgio A, Gatti P, Montesarchio L, Santoro B, Dell’Olio A, Crucinio N, Coppola C, Scarano F, Biase FD, Ciracì E, Semeraro S, Giorgio V. Intrahepatic Cholangiocarcinoma and Thermal Ablation: Long-term Results of An Italian Retrospective Multicenter Study. J Clin Transl Hepatol 2019; 7:287-292. [PMID: 31915596 PMCID: PMC6943218 DOI: 10.14218/jcth.2019.00036] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/15/2019] [Accepted: 11/06/2019] [Indexed: 12/11/2022] [Imported: 08/29/2023] Open
Abstract
Background and Aims: Despite resection being considered the treatment of choice for intrahepatic cholangiocarcinoma (ICC), percutaneous thermal ablation can be an alternative treatment for patients unfit for surgery. Our aim was to compare long-term results of percutaneous sonographically-guided radiofrequency ablation (RFA) with high-powered microwave ablation (MWSA) in treatment of ICC. Methods: Results of 71 ICC patients with 98 nodules treated with RFA (36 patients) or MWSA (35 patients) between January 2008 and June 2018 in 5 Interventional Ultrasound centers of Southern Italy were retrospectively reviewed. Cumulative overall survival curves were calculated with the Kaplan-Meyer method and differences with the log-rank test. Eleven possible factors affecting survival were analyzed. Results: Overall survival of the entire series was 88%, 65%, 45% and 34% at 12, 36, 60 and 80 months, respectively. Patients treated with MWSA survived longer than patients treated with RFA (p < 0.005). The MWSA group with ICC nodules ≤3 cm or nodules up to 4 cm survived longer than the RFA group (p < 0.0005). In patients with nodules >4 cm, no significant difference was found. Disease-free survival and progression-free survival were better in the MWSA group compared to the RFA group (p < 0.005). Diameter of nodules and MWSA were independent factors predicting a better survival. No major complications were observed. Conclusions: MWSA is superior to RFA in treating ICC unfit for surgery, achieving better long-term survival in small (≤3 cm) ICC nodules as well as nodules up to 4 cm of neoplastic tumors and should replace RFA.
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Affiliation(s)
- Antonio Giorgio
- Liver Unit and Interventional Ultrasound Unit, Athena Clinical Institute, Piedimonte Matese (CE), Italy
- Correspondence to: Antonio Giorgio, Liver Unit and Interventional Ultrasound Unit, Athena Clinical Institute, Piedimonte Matese (CE) (81016), Italy. Tel: +39-823784666, E-mail:
| | - Pietro Gatti
- Internal Medicine Unit, Brindisi General Hospital, Brindisi, Italy
| | | | - Bruno Santoro
- Liver Unit and Interventional Ultrasound Unit, Athena Clinical Institute, Piedimonte Matese (CE), Italy
| | - Andrea Dell’Olio
- Department of Radiology, Bisceglie Hospital - ASL BAT, Bisceglie, Italy
| | - Nicola Crucinio
- Gastroenterology Unit, Foggia General Hospital, Foggia, Italy
| | - Carmine Coppola
- Department of Internal Medicine, Hepatology Interventional Unit, Gragnano Hospital, Gragnano (NA), Italy
| | - Ferdinando Scarano
- Department of Internal Medicine, Hepatology Interventional Unit, Gragnano Hospital, Gragnano (NA), Italy
| | - Fabio De Biase
- Gastroenterology Unit, Foggia General Hospital, Foggia, Italy
| | | | | | - Valentina Giorgio
- Fondazione Policlinico A. Gemelli IRCCS, Department of Woman and Child Health and Public Health, Largo A Gemelli, Roma, Italy
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Giorgio A, De Luca M, Gatti P, Matteucci P, Giorgio V. Can contrast-enhanced ultrasound with perfluorobutane add value in detection of hepatocellular carcinoma in cirrhosis during surveillance? Quant Imaging Med Surg 2019; 9:1466-1469. [PMID: 31559175 PMCID: PMC6732065 DOI: 10.21037/qims.2019.07.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 08/29/2023] [Imported: 08/29/2023]
Affiliation(s)
- Antonio Giorgio
- Liver Unit and Interventional Ultrasound Unit, Athena Clinical Institute, Piedimonte Matese (CE), Caserta, Italy
| | - Massimo De Luca
- Liver Unit, Cardarelli Hospital, Largo A Cardarelli, Naples, Italy
| | - Pietro Gatti
- Internal Medicine Unit, Brindisi General Hospital, Brindisi, Italy
| | | | - Valentina Giorgio
- Fondazione Policlinico A. Gemelli IRCCS, Department of Woman and Child Health and Public Health, Largo A Gemelli, Roma, Italy
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Giorgio A, Amendola F, Calvanese A, Ingenito E, Santoro B, Gatti P, Ciracì E, Matteucci P, Giorgio V. Ultrasound-guided percutaneous irreversible electroporation of hepatic and abdominal tumors not eligible for surgery or thermal ablation: a western report on safety and efficacy. J Ultrasound 2019; 22:53-58. [PMID: 30843171 DOI: 10.1007/s40477-019-00372-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 07/12/2018] [Indexed: 02/07/2023] [Imported: 08/29/2023] Open
Abstract
PURPOSE To report our first results on sixteen patients affected by liver and abdominal malignant tumors, unfit for surgery or thermal ablation, treated with US-guided percutaneous irreversible electroporation (IRE). METHODS From June 2014 to December 2016, all patients meeting the inclusion criteria (malignant hepatic or abdominal tumors not eligible for resection or thermal ablation) and not meeting the exclusion criteria (heart arrhythmia, pro-hemorrhagic hematological alterations, tumor size > 8 cm, presence of a biliary metallic stent) referred to our institutions were prospectively enrolled to undergo percutaneous US-guided irreversible electroporation (IRE). Sixteen patients (age range 59-68 years, mean 63; 7 females) with 18 tumors (diameter range 1.3-7.5 cm) fulfilled the inclusion criteria and were included in the study. Data concerning efficacy (tested by a 1-week CEUS and a 4-week enhanced CT and/or enhanced MRI) and safety were recorded during a 18-month follow up. RESULTS All patients completed a 35-50-min procedure without complications. One patient with 6 cm Klatskin tumor also underwent a second session for 1 month. A 1-week CEUS and a 4-week e-CT and/or e-MRI arterial phase contrast enhancement analysis showed an overall reduction of arterial flow with confirmation of unenhanced lesions for seven nodules. After 1-18 months of follow up, no major complications were recorded and no tumor-related death occurred. The lesions of two patients disappeared 3 and 6 months after their treatment, respectively. CONCLUSIONS IRE is a promising ablation modality in the treatment of malignant hepatic and abdominal tumors unsuitable for resection or thermal ablation.
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Affiliation(s)
- A Giorgio
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
| | - F Amendola
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - A Calvanese
- Oncology Unit, Tortorella Clinical Institute, Salerno, Italy
| | - E Ingenito
- Oncology Unit, Tortorella Clinical Institute, Salerno, Italy
| | - B Santoro
- Interventional Ultrasound Unit, Athena Clinical Institute, Caserta, Italy
| | - P Gatti
- Internal Medicine Unit, Ostuni Hospital, Ostuni (BR), Italy
| | - E Ciracì
- Internal Medicine Unit, Ostuni Hospital, Ostuni (BR), Italy
| | - P Matteucci
- Radiation Therapy Unit, Campus Biomedico University, Rome, Italy
| | - V Giorgio
- Pediatric Gastroenterology Unit, Fondazione Policlinico A.Gemelli IRCCS, Department of Woman and Child Health and Public Health; Roma- Italy, Rome, Italy
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Giorgio A, Gatti P, Montesarchio L, Merola MG, Amendola F, Calvanese A, Iaquinto G, Fontana M, Ciracì E, Semeraro S, Santoro B, Coppola C, Matteucci P, Giorgio V. Microwave Ablation in Intermediate Hepatocellular Carcinoma in Cirrhosis: An Italian Multicenter Prospective Study. J Clin Transl Hepatol 2018; 6:251-257. [PMID: 30271736 PMCID: PMC6160301 DOI: 10.14218/jcth.2018.00013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/04/2018] [Accepted: 04/16/2018] [Indexed: 02/07/2023] [Imported: 08/29/2023] Open
Abstract
Background and Aims: To report long-term results in treatment of intermediate hepatocellular carcinoma (HCC) in cirrhotics using new high-powered microwaves (MWS) ablation alone. Methods: This multicenter study included 215 cirrhotics (age range: 67-84 years; 137 males; 149 Child A, 66 Child B) who underwent percutaneous ultrasound-guided high-powered MWS ablation instead of transarterial chemoembolization. Among the patient population, 109 had a single nodule (Ø 5.3-8 cm) [group A], 70 had 2 nodules (Ø 3-6 cm) [group B] and 36 had 3-5 nodules (Ø 1.5-6.8 cm) [group C]. MWS ablation efficacy was evaluated using enhanced-computed tomography and/or magnetic resonance imaging. Primary end-point was 5-year cumulative overall survival (OS). Results: On enhanced-computed tomography and/or magnetic resonance imaging, complete ablation rates were 100% for 1.5-3.5 cm nodules. In nodules >3.5-5 cm, it was 89% for the first ablation and 100% for the second. For lesions >5-8 cm, ablation was up to 92%. Overall, 1-, 3- and 5-year survival rates were 89, 60, and 21%, respectively. The cumulative OS rate of group A was 89%, 66% and 34% at 1, 3 and 5 years. The cumulative OS rate of group B was 88%, 60% and 11% at 1, 3 and 5 years. The cumulative OS rate of group C was 86%, 55% and 0%. The 5-year survival rate was significantly different among the groups (p <0.001). One patient died from rupture of HCC. Upon multivariate analysis, preablation total bilirubin >1.5 mg/dL was an independent factor for predicting lower survival. Conclusions: Percutaneous MWS ablation of intermediate HCC is safe and effective in inducing large volume of necrosis in intermediate HCC nodules, providing long-term survival rates similar to transarterial chemoembolization. Preablation total bilirubin >1.5 mg/dL as expression of liver function reserve is the main factor predicting a worse outcome.
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Affiliation(s)
- Antonio Giorgio
- Department of Internal Medicine, Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy
- Department of Surgery, Interventional Ultrasound Unit, Ruesch Clinical Institute, Naples, Italy
| | - Pietro Gatti
- Department of Internal Medicine, Interventional Ultrasound Unit, Ostuni Hospital, Ostuni, Italy
| | - Luca Montesarchio
- Department of Internal Medicine, Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy
| | | | - Ferdinando Amendola
- Department of Internal Medicine, Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy
| | - Andrea Calvanese
- Department of Internal Medicine, Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy
| | - Gaetano Iaquinto
- Interventional Ultrasound Unit, S. Rita Medical-Surgical Hospital, Atripalda, Italy
| | - Massimiliano Fontana
- Interventional Ultrasound Unit, S. Rita Medical-Surgical Hospital, Atripalda, Italy
| | - Emanuela Ciracì
- Department of Internal Medicine, Interventional Ultrasound Unit, Ostuni Hospital, Ostuni, Italy
| | - Stefano Semeraro
- Department of Internal Medicine, Interventional Ultrasound Unit, Ostuni Hospital, Ostuni, Italy
| | - Bruno Santoro
- Interventional Ultrasound Unit, Athena Clinical Institute, Piedimonte, Italy
| | - Carmine Coppola
- Department of Internal Medicine, Hepatology Interventional Unit, Gragnano Hospital, Gragnano, Italy
| | - Paolo Matteucci
- Department of Radiation Oncology, Campus Biomedico University, Rome, Italy
| | - Valentina Giorgio
- Department of Pediatrics, Fondazione Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence to: Antonio Giorgio, Tortorella Clinical Hospital, Salerno 80131, Italy. Tel: +39-081-248-3198, E-mail:
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Affiliation(s)
- Antonio Giorgio
- Interventional Ultrasound Unit, Tortorella Clinical Hospital, Salerno, Italy
| | - Pietro Gatti
- Internal Medicine Division, Ostuni Hospital, Ostuni BR, Italy
| | - Paolo Matteucci
- Radiation Oncology Institute, Campus Biomedico University, Rome, Italy
| | - Valentina Giorgio
- Pediatric Gastroenterology Unit, Sacred Heart University, Policlinico Gemelli, Rome, Italy
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Giorgio A, Merola MG, Montesarchio L, Merola F, Gatti P, Coppola C, Giorgio V, Calisti G. Percutaneous radiofrequency ablation of hepatocellular carcinoma in cirrhosis: analysis of complications in a single centre over 20 years. Br J Radiol 2017; 90:20160804. [PMID: 28402124 DOI: 10.1259/bjr.20160804] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] [Imported: 08/29/2023] Open
Abstract
OBJECTIVE To report on our 20 years' experience on complications after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) in patients with cirrhosis. METHODS From 1994 to 2014, 1787 RFA procedures were performed percutaneously in 1162 patients with cirrhosis (852 Child A and 310 Child B) with HCC nodules (1.2-7 cm), prothrombin time >50%, platelet count of 50.000 mm3 and total bilirubin ranging from 0.80 to 4.5 mg dl-1. In 67 patients, RFA was performed on both intraparenchymal HCC nodule and tumour thrombus extended in the main portal vein and/or its branches. RESULTS Four patients (0.3%) died after RFA. 39 patients (3.2%) changed in Child's class: 26 out of 28 Child A patients with cirrhosis changed to Child B and 2 changed to Child C class; 11 Child B patients changed to Child C class. On multivariate analysis, the total bilirubin pre-RFA was the only independent risk factor for impairment of liver function and death. Complications were hemoperitoneum, abscess and intrahepatic haematoma. CONCLUSION RFA of HCC in patients with cirrhosis is safe, even in case of invasion of the portal venous system. Functional liver reserve should be strictly monitored, mainly when pre-RFA total bilirubin value is >2.5 mg dl-1. The study was approved by our institutional review board. Advances in knowledge: The total bilirubin value >2.5 mg dl-1 represents the main marker of functional liver reserve that predicts decompensation of liver cirrhosis in patients undergoing RFA for HCC.
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Affiliation(s)
- Antonio Giorgio
- 1 Interventional Ultrasound Unit, D Cotugno Hospital, Naples, Italy.,2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Maria G Merola
- 2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Luca Montesarchio
- 2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Francesca Merola
- 2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Pietro Gatti
- 2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Carmine Coppola
- 2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Valentina Giorgio
- 2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Giorgio Calisti
- 2 Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
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Giorgio A, Montesarchio L, Gatti P, Amendola F, Matteucci P, Santoro B, Merola MG, Merola F, Coppola C, Giorgio V. Contrast-Enhanced Ultrasound: a Simple and Effective Tool in Defining a Rapid Diagnostic Work-up for Small Nodules Detected in Cirrhotic Patients during Surveillance. J Gastrointestin Liver Dis 2017; 25:205-11. [PMID: 27308652 DOI: 10.15403/jgld.2014.1121.252.chu] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] [Imported: 08/29/2023]
Abstract
BACKGROUND AND AIMS Disappearance of portal blood flow and arterial vascularization is the hallmark of hepatocarcinogenesis. The capability of a dynamic imaging modality detecting arterial hypervascularization of small nodules is crucial to promote a rapid diagnostic and therapeutic work-up improving survival. We aimed to evaluate the capability of CEUS to detect arterial vascularization of ≤ 2 cm HCC nodules arising during surveillance so as to shorten the diagnostic and therapeutic work-up. METHODS From October 2009 to September 2014, among 1757 consecutive cirrhotic patients under surveillance with ultrasound (US), 243 patients had new single nodules 7-20 mm; 229/243 had a conclusive histologic diagnosis and comprised the study group. All patients underwent CEUS followed by enhanced MRI and US guided percutaneous 18G needle core biopsy of the nodules. Of the 229 nodules, 27 were hyperechoic, 171 hypoechoic and 31 isoechoic lesions. RESULTS The histology results revealed that 199/229 nodules were HCC and 30 were benign. Of 199 HCC, CEUS evidenced arterial hypervascularity in 190 nodules (95.5%) (sensitivity 94.48 %, specificity 100%, PPV 100%, NPV 76.92 %). Of the 39 CEUS arterial-unenhanced nodules, 30 were benign and 9 (23%) were well-differentiated HCC. eMRI showed arterial hypervascularity in 199 nodules (86,9%). Of these, only 193 (97%) were histologically HCCs while 6 were benign (sensitivity: 97%, specificity: 80%, PPV: 97%, NPV: 80%). CONCLUSIONS CEUS has a great capability to detect arterial hypervascularity of small HCC. Because only 4.5% of new nodules escape the demonstration of arterial hyervascularity, CEUS must be performed immediately after conventional US to contrast the malignant fate of small lesions arising in a cirrhotic liver.
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Affiliation(s)
- Antonio Giorgio
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy.
| | - Luca Montesarchio
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Piero Gatti
- Department of Oncology, University Hospital of Bari, Bari, Italy
| | - Ferdinando Amendola
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Paolo Matteucci
- Radiotherapy and Oncology Department, Campus Biomedico University, Rome, Italy
| | - Bruno Santoro
- Interventional Ultrasound Unit, Athena Cinical Institute, Caserta, Italy
| | | | - Francesca Merola
- Interventional Ultrasound Unit, Athena Cinical Institute, Caserta, Italy
| | - Carmine Coppola
- Hepatology and Interventional US Unit, Gragnano Hospital, Gragnano, Italy
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Giorgio A, Merola MG, Montesarchio L, Merola F, Santoro B, Coppola C, Gatti P, Amendola F, DI Sarno A, Calvanese A, Matteucci P, Giorgio V. Sorafenib Combined with Radio-frequency Ablation Compared with Sorafenib Alone in Treatment of Hepatocellular Carcinoma Invading Portal Vein: A Western Randomized Controlled Trial. Anticancer Res 2017; 36:6179-6183. [PMID: 27793949 DOI: 10.21873/anticanres.11211] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/07/2016] [Indexed: 12/13/2022] [Imported: 08/29/2023]
Abstract
AIM To compare in a randomized controlled trial (RCT) 3-year survival of cirrhotic patients with hepatocellular carcinoma (HCC) accompanied by portal vein tumor thrombus (PVTT) treated with sorafenib plus percutaneous radiofrequency ablation (RFA) of both intraparenchymal HCC and PVTT (combination Group) or sorafenib alone (sorafenib-alone Group). PATIENTS AND METHODS Ninety-nine consecutive Child A cirrhotics were randomized to receive RFA of both HCC and main portal vein tumor thrombus (MPVTT) plus sorafenib (n=49) or sorafenib alone (n=50). RESULTS One-, 2- and 3-year survival rates were 60%, 35% and 26%, respectively, in the combination group and 37% and 0 % at 1- and 2-year, respectively, in the sorafenib alone group. At multivariate analysis, the combination of RFA of both HCC and MPVTT was the only factor predicting survival. CONCLUSION Use of RFA of both HCC and MPVTT plus sorafenib significantly increases 3-year survival compared to sorafenib alone.
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Affiliation(s)
- Antonio Giorgio
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy .,Interventional Ultrasound Unit, Athena Cinical Institute, Caserta, Italy
| | | | - Luca Montesarchio
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Francesca Merola
- Interventional Ultrasound Unit, Athena Cinical Institute, Caserta, Italy
| | - Bruno Santoro
- Interventional Ultrasound Unit, Athena Cinical Institute, Caserta, Italy
| | | | - Pietro Gatti
- Internal Medicine Unit, Ostuni Hospital, Brindisi, Italy
| | - Ferdinando Amendola
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | | | - Andrea Calvanese
- Interventional Ultrasound Unit, Tortorella Clinical Institute, Salerno, Italy
| | - Paolo Matteucci
- Radiotherapy and Oncology Department, Campus Biomedico University, Rome, Italy
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Giorgio A, Giorgio V, Matteucci P. Poor contrast enhanced ultrasonography! There is no limit to its decline in the diagnosis of hepatocellular carcinoma on cirrhosis! J Hepatol 2015; 62:1452-3. [PMID: 25703081 DOI: 10.1016/j.jhep.2015.01.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Revised: 01/14/2015] [Accepted: 01/15/2015] [Indexed: 12/04/2022] [Imported: 08/29/2023]
Affiliation(s)
- Antonio Giorgio
- Interventional Ultrasound Unit, Tortorella Clinical Institute, ISSMES Consortium, Salerno, Italy.
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