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Longo UG, De Tommasi F, Salvatore G, Lalli A, Lo Presti D, Massaroni C, Schena E. Intra-articular temperature monitoring during radiofrequency ablation in ex-vivo bovine hip joints via Fiber Bragg grating sensors. BMC Musculoskelet Disord 2023; 24:766. [PMID: 37770871 PMCID: PMC10537081 DOI: 10.1186/s12891-023-06836-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 08/26/2023] [Indexed: 09/30/2023] Open
Abstract
PURPOSE Radiofrequency ablation is an increasingly used surgical option for ablation, resection and coagulation of soft tissues in joint arthroscopy. One of the major issues of thermal ablation is the temperature monitoring across the target areas, as cellular mortality is a direct consequence of thermal dosimetry. Temperatures from 45 °C to 50 °C are at risk of damage to chondrocytes. One of the most reliable tools for temperature monitoring is represented by fiber optic sensors, as they allow accurate and real-time temperature measurement via a minimally invasive approach. The aim of this study was to determine, by fiber Bragg grating sensors (FBGs), the safety of radiofrequency ablation in tissue heating applied to ex-vivo bovine hip joints. METHODS Ex vivo bovine hips were subjected to radiofrequency ablation, specifically in the acetabular labrum, for a total of two experiments. The WEREWOLF System (Smith + Nephew, Watford, UK) was employed in high operating mode and in a controlled ablation way. One optical fiber embedding seven FBGs was used to record multipoint temperature variations. Each sensor was 1 mm in length with a distance from edge to edge with each other of 2 mm. RESULTS The maximum variation was recorded in both the tests by the FBG1 (i.e., the closest one to the electrode tip) and was lower than to 2.8 °C. The other sensors (from FBG2 to FBG7) did not record a significant temperature change throughout the duration of the experiment (maximum up to 0.7 °C for FBG7). CONCLUSIONS No significant increase in temperature was observed at any of the seven sites. The sensor nearest to the radiofrequency source exhibited the highest temperature rise, but the variation was only 3 °C. The minimal temperature increase registered at the measurement sites, according to existing literature, is not expected to be cytotoxic. FBGs demonstrate the potential to fulfil the strict requirements for temperature measurements during arthroscopic surgery.
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Affiliation(s)
- Umile Giuseppe Longo
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128, Italy.
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128, Italy.
| | - Francesca De Tommasi
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128, Italy
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Trigoria, Rome, 00128, Italy
| | - Giuseppe Salvatore
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128, Italy
| | - Alberto Lalli
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128, Italy
- Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, Roma, 00128, Italy
| | - Daniela Lo Presti
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Trigoria, Rome, 00128, Italy
| | - Carlo Massaroni
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Trigoria, Rome, 00128, Italy
| | - Emiliano Schena
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, Roma, 00128, Italy
- Unit of Measurements and Biomedical Instrumentation, Università Campus Bio-Medico di Roma, via Alvaro del Portillo, 200, Trigoria, Rome, 00128, Italy
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Bertolotti L, Segato F, Pagnini F, Buti S, Casarin A, Celia A, Ziglioli F, Maestroni U, Pedrazzi G, Ascenti V, Martini C, Cicero C, De Filippo M. Percutaneous Ablation of T1 Renal Masses: Comparative Local Control and Complications after Radiofrequency and Cryoablation. Diagnostics (Basel) 2023; 13:3059. [PMID: 37835802 PMCID: PMC10572527 DOI: 10.3390/diagnostics13193059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 08/30/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023] Open
Abstract
The efficacy and complication rates of percutaneous radiofrequency ablation (RFA) and cryoablation (CA) in the treatment of T1 renal masses in two Northern Italy hospitals were retrospectively investigated. Eighty-two patients with 80 T1a tumors and 10 T1b tumors treated with thermal ablation from 2015 through 2020 were included. A total of 43 tumors in 38 patients were treated with RFA (2.3 ± 0.9 cm), and 47 tumors in 44 patients were treated with CA (2.1 ± 0.8 cm). The mean follow-up observation period was 26 ± 19 months. The major complications and efficacy, as measured using the technical success and local tumor recurrence rates, were recorded. There were three (6.9%) technical failures with RFA and one (2.1%) with cryoablation (p = 0.30). Among the 40 tumors that were successfully treated with RFA, 1 tumor (2.5%) developed local tumor recurrence; 5/46 tumors that were treated with cryoablation (10.8%) developed local tumor recurrence (p = 0.17). T1b lesions (4.0 ± 0.7 cm) resulted in 1/6 technically unsuccessful cases with RFA and 0/4 with CA. No recurrent disease was detected in the T1b lesions. Major complications occurred after 2.3% (1/43) of RFAs and 0/47 of cryoablation procedures. RFA and cryoablation are both effective in the treatment of renal masses. Major complications with either procedure are uncommon.
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Affiliation(s)
- Lorenzo Bertolotti
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Via Gramsci 14, 43126 Parma, PR, Italy; (L.B.); (F.P.); (M.D.F.)
| | - Federica Segato
- G.B. Rossi University Hospital, University of Verona, 37134 Verona, VR, Italy;
| | - Francesco Pagnini
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Via Gramsci 14, 43126 Parma, PR, Italy; (L.B.); (F.P.); (M.D.F.)
| | - Sebastiano Buti
- Department of Medicine and Surgery, University of Parma–Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, PR, Italy;
| | - Andrea Casarin
- Department of Radiology, San Bassiano Hospital, 36061 Bassano del Grappa, VI, Italy; (A.C.); (C.C.)
| | - Antonio Celia
- Department of Urology, San Bassiano Hospital, 36061 Bassano del Grappa, VI, Italy;
| | - Francesco Ziglioli
- Department of Urology, Parma University Hospital, Via Gramsci 14, 43126 Parma, PR, Italy; (F.Z.); (U.M.)
| | - Umberto Maestroni
- Department of Urology, Parma University Hospital, Via Gramsci 14, 43126 Parma, PR, Italy; (F.Z.); (U.M.)
| | - Giuseppe Pedrazzi
- Centre of Statistic, Department of Medicine and Surgery, University of Parma, 43126 Parma, PR, Italy;
| | - Velio Ascenti
- Postgraduate School of Radiodiagnostics, Policlinico Universitario, University of Milan, 20133 Milano, MI, Italy;
| | - Chiara Martini
- Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Via Gramsci 14, 43126 Parma, PR, Italy
| | - Calogero Cicero
- Department of Radiology, San Bassiano Hospital, 36061 Bassano del Grappa, VI, Italy; (A.C.); (C.C.)
| | - Massimo De Filippo
- Section of Radiology, Department of Medicine and Surgery, University of Parma, Maggiore Hospital, Via Gramsci 14, 43126 Parma, PR, Italy; (L.B.); (F.P.); (M.D.F.)
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Wessendorf J, Scheschenja M, Bastian MB, König AM, Pagenstecher A, Helmprobst F, Buchholz M, Tatura M, Jedelská J, Mahnken AH. Feasibility of the chick chorioallantoic membrane model for preclinical studies on tumor radiofrequency ablation. Eur Radiol Exp 2023; 7:56. [PMID: 37749303 PMCID: PMC10519884 DOI: 10.1186/s41747-023-00368-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/04/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND We evaluated the feasibility of a chick chorioallantoic membrane (CAM) tumor model for preclinical research on tumor radiofrequency ablation (RFA). METHODS Fertilized chicken eggs were incubated and divided into five cohorts: RFA for 30 s (n = 5), RFA for 60 s (n = 5), RFA for 120 s (n = 4), sham (n = 8), and controls (n = 6). Xenografting using pancreatic neuroendocrine tumor cells of the BON-1 cell line was performed on embryonic day (ED) 8. The RFA was performed on ED 12. Survival, stereomicroscopic observations, and histological observations using hematoxylin-eosin (H&E) and Ki67 staining were evaluated. RESULTS The survival rates in the 30-s, 60-s, and 120-s, sham and control cohort were 60%, 60%, 0%, 100%, and 50%, respectively. Signs of bleeding and heat damage were common findings in the evaluation of stereomicroscopic observations. Histological examination could be performed in all but one embryo. Heat damage, bleeding, thrombosis, and leukocyte infiltration and hyperemia were regular findings in H&E-stained cuts. A complete absence of Ki67 staining was recorded in 33.3% and 50% of embryos in the 30-s and 60-s cohorts that survived until ED 14, respectively. CONCLUSIONS The CAM model is a feasible and suiting research model for tumor RFA with many advantages over other animal models. It offers the opportunity to conduct in vivo research under standardized conditions. Further studies are needed to optimize this model for tumor ablations in order to explore promising but unrefined strategies like the combination of RFA and immunotherapy. RELEVANCE STATEMENT The chick chorioallantoic membrane model allows in vivo research on tumor radiofrequency ablation under standardized conditions that may enable enhanced understanding on combined therapies while ensuring animal welfare in concordance with the "Three Rs." KEY POINTS • The chorioallantoic membrane model is feasible and suiting for tumor radiofrequency ablation. • Radiofrequency ablation regularly achieved reduction but not eradication of Ki67 staining. • Histological evaluation showed findings comparable to changes in humans after RFA. • The chorioallantoic membrane model can enable studies on combined therapies after optimization.
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Affiliation(s)
- Joel Wessendorf
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany.
| | - Michael Scheschenja
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
| | - Moritz B Bastian
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
| | - Alexander M König
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
| | - Axel Pagenstecher
- Mouse Pathology and Electron Microscopy - Core Facility, Institute of Neuropathology, Philipps-University Marburg, Marburg, Germany
| | - Frederik Helmprobst
- Mouse Pathology and Electron Microscopy - Core Facility, Institute of Neuropathology, Philipps-University Marburg, Marburg, Germany
| | - Malte Buchholz
- Clinic for Gastroenterology, Endocrinology, Metabolism and Infectiology, Philipps-University Marburg, Marburg, Germany
| | - Marina Tatura
- Clinic for Gastroenterology, Endocrinology, Metabolism and Infectiology, Philipps-University Marburg, Marburg, Germany
| | - Jarmila Jedelská
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
- Small Animal MRI - Core Facility, Center for Tumor Biology and Immunology (ZTI), Philipps-University Marburg, Marburg, Germany
| | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, University Hospital Marburg, Philipps-University Marburg, Marburg, Germany
- Small Animal MRI - Core Facility, Center for Tumor Biology and Immunology (ZTI), Philipps-University Marburg, Marburg, Germany
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Rasic G, de Geus SWL, Beaulieu-Jones B, Kasumova GG, Kent TS, Ng SC, McAneny D, Tseng JF, Sachs TE. A nationwide propensity score analysis comparing ablation and resection for hepatocellular carcinoma. J Surg Oncol 2023; 127:1125-1134. [PMID: 36905338 DOI: 10.1002/jso.27232] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Studies have reported ambiguous results regarding the efficacy of ablation for early-stage hepatocellular carcinoma (HCC). Our study compared outcomes of ablation versus resection for HCC ≤50 mm to identify tumor sizes that would most benefit from ablation in terms of long-term survival. METHODS The National Cancer Database was queried for patients with stage I and II HCC ≤50 mm who underwent ablation or resection (2004-2018). Three cohorts were created based on tumor size: ≤20, 21-30, and 31-50 mm. A propensity score-matched survival analysis was performed using the Kaplan-Meier method. RESULTS In total, 36.47% (n = 4263) and 63.53% (n = 7425) of patients underwent resection and ablation, respectively. After matching, resection was associated with a significant survival benefit compared to ablation (3-year survival: 78.13% vs. 67.64%; p < 0.0001) in patients with HCC of ≤20 mm. The impact of resection was even more striking among patients with HCC of 21-30 mm (3-year survival: 77.88% vs. 60.53%; p < 0.0001) and 31-50 mm (3-year survival: 67.21% vs. 48.55%; p < 0.0001). CONCLUSIONS While resection offers a survival benefit over ablation in the treatment of early-stage HCC ≤50 mm, ablation may provide a feasible bridging strategy in patients awaiting transplantation.
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Affiliation(s)
- Gordana Rasic
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Susanna W L de Geus
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Brendin Beaulieu-Jones
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Gyulnara G Kasumova
- Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Tara S Kent
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Sing Chau Ng
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - David McAneny
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Jennifer F Tseng
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Teviah E Sachs
- Department of Surgery, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA
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Zou YW, Ren ZG, Sun Y, Liu ZG, Hu XB, Wang HY, Yu ZJ. The latest research progress on minimally invasive treatments for hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 2023; 22:54-63. [PMID: 36041973 DOI: 10.1016/j.hbpd.2022.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 08/09/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fourth leading cause of cancer-related death worldwide. Due to the high prevalence of hepatitis B virus (HBV) infection in China, the incidence of HCC in China is high, and liver cirrhosis caused by chronic hepatitis also brings great challenges to treatment. This paper reviewed the latest research progress on minimally invasive treatments for HCC, including percutaneous thermal ablation and new nonthermal ablation techniques, and introduced the principles, advantages, and clinical applications of various therapeutic methods in detail. DATA SOURCES The data of treatments for HCC were systematically collected from the PubMed, ScienceDirect, American Chemical Society and Web of Science databases published in English, using "minimally invasive" and "hepatocellular carcinoma" or "liver cancer" as the keywords. RESULTS Percutaneous thermal ablation is still a first-line strategy for the minimally invasive treatment of HCC. The effect of microwave ablation (MWA) on downgrading treatment before liver transplantation is better than that of radiofrequency ablation (RFA), while RFA is more widely used in the clinical practice. High-intensity focused ultrasound (HIFU) is mainly used for the palliative treatment of advanced liver cancer. Electrochemotherapy (ECT) delivers chemotherapeutic drugs to the target cells while reducing the blood supply around HCC. Irreversible electroporation (IRE) uses a microsecond-pulsed electric field that induces apoptosis and necrosis and triggers a systemic immune response. The nanosecond pulsed electric field (nsPEF) has achieved a good response in the ablation of mice with HCC, but it has not been reported in China for the treatment of human HCC. CONCLUSIONS A variety of minimally invasive treatments provide a sufficient survival advantage for HCC patients. Nonthermal ablation will lead to a new wave with its unique advantage of antitumor recurrence and metastasis.
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Affiliation(s)
- Ya-Wen Zou
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zhi-Gang Ren
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Ying Sun
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zhen-Guo Liu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Key Laboratory of Pulsed Power Translational Medicine of Zhejiang Province, 2959 Yuhangtang Road, Hangzhou 310000, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Xiao-Bo Hu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Hai-Yu Wang
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
| | - Zu-Jiang Yu
- Department of Infectious Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China; Gene Hospital of Henan Province; Precision Medicine Center, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China.
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Zhao J, Wang L, Zhang Y, He H, Zhao P, Luo Y. Predictors of metastasis in cervical indeterminate lymph nodes after thyroid cancer ablation by long-term ultrasound follow-up. Int J Hyperthermia 2023; 40:2207792. [PMID: 37156534 DOI: 10.1080/02656736.2023.2207792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
OBJECTIVES To investigate the pattern of change over time and predictors for metastasis in indeterminate lymph nodes (LNs) among patients with thyroid cancer post-ablation. METHODS We enrolled patients who developed new cervical LNs after papillary thyroid carcinoma (PTC) ablation. Changes in the ultrasound characteristics of the indeterminate LN were recorded at months 1, 3, 6 and 12 after ablation. LN puncture pathology and long-term follow-up were standard of diagnosis. The indeterminate LNs were divided into benign and malignant groups, the differences between the two groups were compared, and the risk characteristics of malignant LNs were screened using generalized estimating equations (GEE). RESULTS In total, we included 138 LNs from 99 patients, of which 48 were indeterminate LNs. When following up indeterminate LNs, non-cervical lymph node metastasis (non-CLNM) lesions demonstrated a statistically significant gradual decrease in volume (p = 0.012), though there was no significant change in the volume of CLNM lesions (p = 0.779). Compared to non-CLNM lesions, the diagnostic efficiency was the highest for CLNM lesions at 1-3 months after ablation, when the LN volume changed by -0.08 to 0.12 mL (p = 0.048). The third month after ablation became an important time point for review. Moreover, GEE analysis showed that microcalcifications, cystic changes, and vascularity were strongly associated with CLNMs (p = 0.004, p = 0.002, and p = 0.010, respectively). CONCLUSIONS There is a pattern of volume change of indeterminate LNs after PTC ablation, which, together with microcalcifications, cystic changes, and vascularity, can be used as criteria for differentiating the benignity and malignancy of indeterminate LNs.
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Affiliation(s)
- Jiahang Zhao
- Medical School of Chinese PLA, Haidian District, Beijing, China
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Longxia Wang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Yan Zhang
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Hongying He
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Ping Zhao
- Medical School of Chinese PLA, Haidian District, Beijing, China
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
| | - Yukun Luo
- Department of Ultrasound, First Medical Center, Chinese PLA General Hospital, Haidian District, Beijing, China
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Sulaiman SRK, Al-Zubaidi SAM, Sakrana AA. Radio Frequency Ablation for the Treatment of Appendicular Skeleton Chondroblastoma: Is It an Excellent Alternative? Systematic Review and Meta-Analysis. Indian J Radiol Imaging 2022; 32:523-530. [DOI: 10.1055/s-0042-1755248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
AbstractRadio frequency ablation (RFA) is a minimally invasive technique that has become recognized in clinical practice for treating chondroblastoma, although curettage with bone graft is the standard treatment. Chondroblastoma is a locally aggressive cartilaginous bone tumor, representing nearly 5% of benign bone tumors. Chondroblastoma shows a preference toward the epiphysis or apophysis of long bones, but it was also reported in vertebrae and flat bones. The management of chondroblastoma could be challenging due to the risk to injure the epiphyseal plate or difficult location. The aim of this study was to determine if RFA is a suitable alternative to curettage with bone graft for the treatment of chondroblastoma. Moreover, there will be an evaluation of RFA's effectiveness in terms of symptoms relief; we also define the proper size of the lesion to be treated with RFA, and discuss the complications after the procedure, including the recurrence rate. Furthermore, we review the best imaging method to evaluate the therapeutic response of RFA and for the detection of residual disease early after the ablation. A comprehensive PubMed and Google Scholar search followed the Preferred Reporting Items for Systematic Review and Meta-Analysis 2020 checklist guidelines. Ninety-seven patients were identified after reviewing the available full texts of nine articles. The results of the current review provide further evidence to support the use of RFA as an alternative option to surgery.
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Affiliation(s)
| | | | - Amal Abdelsattar Sakrana
- Department of Diagnostic and Interventional Radiology, Mansoura University Hospital, Mansoura, Egypt
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Luerken L, Haimerl M, Doppler M, Uller W, Beyer LP, Stroszczynski C, Einspieler I. Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. ROFO-FORTSCHR RONTG 2022; 194:1075-1086. [PMID: 35545102 DOI: 10.1055/a-1768-0954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is the fifth most common tumor worldwide. Because many hepatocellular carcinomas are already unresectable at the time of initial diagnosis, percutaneous tumor ablation has become established in recent decades as a curative therapeutic approach for very early (BCLC 0) and early (BCLC A) HCC. The aim of this paper is to provide a concise overview of the percutaneous local ablative procedures currently in use, based on their technical characteristics as well as clinical relevance, taking into account the current body of studies. MATERIALS AND METHODS The literature search included all original papers, reviews, and meta-analyses available via MEDLINE and Pubmed on the respective percutaneous ablation procedures; the primary focus was on randomized controlled trials and publications from the last 10 years. RESULTS AND CONCLUSIONS Radiofrequency ablation (RFA) and microwave ablation (MWA) are well-established procedures that are considered equal to surgical resection in the treatment of stage BCLC 0 and A HCC with a diameter up to 3 cm due to their strong evidence in international and national guidelines. For tumors with a diameter between 3 and 5 cm, the current S3 guidelines recommend a combination of transarterial chemoembolization (TACE) and thermal ablation using RFA or MWA as combination therapy is superior to thermal ablation alone in tumors of this size and shows comparable results to surgical resection in terms of overall survival. Alternative, less frequently employed thermal procedures include cryotherapy (CT) and laser ablation (LA). Non-thermal procedures include irreversible electroporation (IRE), interstitial brachytherapy (IBT), and most recently, electrochemotherapy (ECT). Due to insufficient evidence, these have only been used in individual cases and within the framework of studies. However, the nonthermal methods are a reasonable alternative for ablation of tumors adjacent to large blood vessels and bile ducts because they cause significantly less damage to these structures than thermal ablation methods. With advances in the technology of the respective procedures, increasingly good evidence, and advancements in supportive techniques such as navigation devices and fusion imaging, percutaneous ablation procedures may expand their indications for the treatment of larger and more advanced tumors in the coming years. KEY POINTS · RFA and MWA are considered equal to surgical resection as a first-line therapy for the curative treatment of stage BCLC 0 and A HCCs with a diameter of up to 3 cm.. · For HCCs with a diameter between 3 and 5 cm, a combination of TACE and RFA or MWA is recommended. This combination therapy yields results comparable to those of surgical resection in terms of overall survival.. · Due to insufficient evidence, alternative ablation methods have only been used in individual cases and within the framework of studies. However, nonthermal methods, such as IRE, IBT, and, most recently, ECT, are a reasonable alternative for ablation of HCCs adjacent to large blood vessels and bile ducts because they cause significantly less damage to these structures than thermal ablation methods.. CITATION FORMAT · Luerken L, Haimerl M, Doppler M et al. Update on Percutaneous Local Ablative Procedures for the Treatment of Hepatocellular Carcinoma. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1768-0954.
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Affiliation(s)
- Lukas Luerken
- Department of Radiology, University Hospital Regensburg, Germany
| | - Michael Haimerl
- Institut für Röntgendiagnostik, University Hospital Regensburg, Germany
| | - Michael Doppler
- Department of Radiology, University Hospital Freiburg Department of Radiology, Freiburg, Germany
| | - Wibke Uller
- Department of Radiology, University Hospital Freiburg Department of Radiology, Freiburg, Germany
| | - Lukas Philipp Beyer
- Institut für Röntgendiagnostik, University Hospital Regensburg, Germany.,Diagnostische und Interventionelle Radiologie, Klinikum Ernst von Bergmann gGmbH, Potsdam, Germany
| | | | - Ingo Einspieler
- Department of Radiology, University Hospital Regensburg, Germany
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Pueyo-Périz E, Téllez-Marquès C, Radosevic A, Morató O, Visa L, Ilzarbe L, Berjano E, de Vicente E, Poves I, Ielpo B, Grande L, Burdío F, Sánchez-Velázquez P. Radiofrequency-assisted transection of the pancreas vs stapler in distal pancreatectomy: a propensity score matched cohort analysis. Sci Rep 2022; 12:7486. [PMID: 35523857 PMCID: PMC9076639 DOI: 10.1038/s41598-022-11583-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 04/25/2022] [Indexed: 12/20/2022] Open
Abstract
To demonstrate the efficacy of radiofrequency for pancreatic stump closure in reducing the incidence of postoperative pancreatic fistula (POPF) in distal pancreatectomy (DP) compared with mechanical transection methods. Despite all the different techniques of pancreatic stump closure proposed for DP, best practice for avoiding POPF remains an unresolved issue, with an incidence of up to 30% regardless of center volume or surgical expertise. DP was performed in a cohort of patients by applying radiofrequency to stump closure (RF Group) and compared with mechanical closure (Control Group). A propensity score (PS) matched cohort study was carried out to minimize bias from nonrandomized treatment assignment. Cohorts were matched by PS accounting for factors significantly associated with either undergoing RF transection or mechanical closure through logistic regression analysis. The primary end-point was the incidence of clinically relevant POPF (CR-POPF). Of 89 patients included in the whole cohort, 13 case patients from the RF-Group were 1:1 matched to 13 control patients. In both the first independent analysis of unmatched data and subsequent adjustment to the overall propensity score-matched cohort, a higher rate of CR-POPF in the Control Group compared with the RF-Group was detected (25.4% vs 5.3%, p = 0.049 and 53.8% vs 0%; p = 0.016 respectively). The RF Group showed better outcomes in terms of readmission rate (46.2% vs 0%, p = 0.031). No significant differences were observed in terms of mortality, major complications (30.8% vs 0%, p = 0.063) or length of hospital stay (5.7 vs 5.2 days, p = 0.89). Findings suggest that the RF-assisted technique is more efficacious in reducing CR-POPF than mechanical pancreatic stump closure.
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Affiliation(s)
- E Pueyo-Périz
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain.
| | - C Téllez-Marquès
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain
| | - A Radosevic
- Department of Radiology, Hospital del Mar, Passeig Maritim 25-29, Barcelona, Spain
| | - O Morató
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain
| | - L Visa
- Department of Oncology, Hospital del Mar-IMIM-CIBERONC, Passeig Maritim 25-29, Barcelona, Spain
| | - L Ilzarbe
- Department of Gastroenterology, Hospital del Mar, Passeig Maritim 25-29, Barcelona, Spain
| | - E Berjano
- BioMIT, Department of Electronic Engineering, Universitat Politècnica de València, Valencia, Spain
| | - E de Vicente
- Department of Surgery, Hospital Sanchinarro, Madrid, Spain
| | - I Poves
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain
| | - B Ielpo
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain
| | - L Grande
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain
| | - F Burdío
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain
| | - P Sánchez-Velázquez
- Division of Hepato-Biliary and Pancreatic Surgery, Department of Surgery, University Hospital del Mar-IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, Barcelona, Spain.
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10
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Kamarinos NV, Vakiani E, Fujisawa S, Gonen M, Fan N, Romin Y, Do RKG, Ziv E, Erinjeri JP, Petre EN, Sotirchos VS, Camacho JC, Solomon SB, Manova K, Sofocleous CT. Immunofluorescence Assay of Ablated Colorectal Liver Metastases: The Frozen Section of Image-Guided Tumor Ablation? J Vasc Interv Radiol 2022; 33:308-315.e1. [PMID: 34800623 PMCID: PMC9531411 DOI: 10.1016/j.jvir.2021.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/20/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE To validate an immunofluorescence assay (IFA) detecting residual viable tumor (VT) as intraprocedural thermal ablation (TA) zone assessment and demonstrate its prognostic value for local tumor progression (LTP) after colorectal liver metastasis (CLM) TA. MATERIALS AND METHODS This prospective study, approved by the institutional review board, included 99 patients with 155 CLMs ablated between November 2009 and January 2019. Tissue samples from the ablation zone (AZ) center and minimal margin underwent immunofluorescent microscopic examination interrogating cellular morphology and mitochondrial viability (IFA) within 30 minutes after ablation. The same tissue samples were subsequently evaluated with standard morphologic and immunohistochemical methods. The sensitivity, specificity, and overall accuracy of IFA versus standard morphologic and immunohistochemical examination were calculated. The LTP-free survival rates were evaluated for the 12-month follow-up period. RESULTS Of the 311 tissue samples stained, 304 (98%) were deemed evaluable. Of these specimens, 27% (81/304) were considered positive for the presence of VT. The accuracy of IFA was 94% (286/304). The sensitivity and specificity were 100% (63/63) and 93% (223/241), respectively. The 18 false-positive IFA assessments corresponded to samples that included viable cholangiocytes. The 12-month LTP-free survival was 59% versus 78% for IFA positive versus negative for VT AZs, respectively (P < .001). There was no difference in LTP between margin positive only and central AZ-positive tumors (25% vs 31%, P = 1). CONCLUSIONS The IFA assessment of the AZ can be completed intraprocedurally and serve as a valid real-time biomarker of complete tumor eradication or detect residual VT after TA. This method could improve tumor control by TA.
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Affiliation(s)
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Sho Fujisawa
- Department of Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York,NY
| | - Mithat Gonen
- Department of Statistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Ning Fan
- Department of Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York,NY
| | - Yevgeniy Romin
- Department of Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York,NY
| | - Richard KG Do
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Etay Ziv
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph P. Erinjeri
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elena N. Petre
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Vlasios S. Sotirchos
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Juan C. Camacho
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Stephen B. Solomon
- Department of Interventional Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Katia Manova
- Department of Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York,NY
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11
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Biopsy and Margins Optimize Outcomes after Thermal Ablation of Colorectal Liver Metastases. Cancers (Basel) 2022; 14:cancers14030693. [PMID: 35158963 PMCID: PMC8833800 DOI: 10.3390/cancers14030693] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 01/14/2022] [Accepted: 01/26/2022] [Indexed: 12/17/2022] Open
Abstract
Simple Summary Thermal ablation (TA) is a non-surgical treatment of cancer that has been used with success in the treatment of colorectal liver metastases (CLM). TA consists of burning the cancer and a rim of surrounding tissue (margin) with a special needle placed in the tumor under image guidance. Despite the technological evolution of TA, tumor progression/recurrence rates remain higher than expected. We present a method that combines tissue and imaging tests performed immediately after ablation to determine whether there is complete tumor destruction or remaining live cancer cells that can cause tumor progression/recurrence. This information can provide guidance for additional treatments for patients with evidence of residual cancer, i.e.,: additional TA at the same or subsequent sitting, or additional chemotherapy and short-interval imaging follow-up to detect recurrence. The presented method proposes a clinical practice paradigm change that can improve clinical outcomes in a large population of patients with CLM treated by TA. Abstract Background: Thermal ablation is a definitive local treatment for selected colorectal liver metastases (CLM) that can be ablated with adequate margins. A critical limitation has been local tumor progression (LTP). Methods: This prospective, single-group, phase 2 study enrolled patients with CLM < 5 cm in maximum diameter, at a tertiary cancer center between November 2009 and February 2019. Biopsy of the ablation zone center and margin was performed immediately after ablation. Viable tumor in tissue biopsy and ablation margins < 5 mm were assessed as predictors of 12-month LTP. Results: We enrolled 107 patients with 182 CLMs. Mean tumor size was 2.0 (range, 0.6–4.6) cm. Microwave ablation was used in 51% and radiofrequency ablation in 49% of tumors. The 12- and 24-month cumulative incidence of LTP was 22% (95% confidence interval [CI]: 17, 29) and 29% (95% CI: 23, 36), respectively. LTP at 12 months was 7% (95% CI: 3, 14) for the biopsy tumor-negative ablation zone with margins ≥ 5 mm vs. 63% (95% CI: 35, 85) for the biopsy-positive ablation zone with margins < 5 mm (p < 0.001). Conclusions: Biopsy-proven complete tumor ablation with margins of at least 5 mm achieves optimal local tumor control for CLM, regardless of the ablation modality used.
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12
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Jeong H, Park W, Kim DH, Na K. Dynamic nanoassemblies of nanomaterials for cancer photomedicine. Adv Drug Deliv Rev 2021; 177:113954. [PMID: 34478780 DOI: 10.1016/j.addr.2021.113954] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/09/2021] [Accepted: 08/27/2021] [Indexed: 12/11/2022]
Abstract
Photomedicine has long been used for treating cancerous diseases. With advances in chemical and material sciences, various types of light-activated photosensitizers (PSs) have been developed for effective photodynamic therapy (PDT) and photothermal therapy (PTT). However, conventional organic/inorganic materials-based PSs lack disease recognition capability and show limited therapeutic effects in addition to side effects. Recently, intelligent dynamic nanoassemblies that are activated in a tumor environment have been extensively researched to target diseased tissues more effectively, for increasing therapeutic effectiveness while minimizing side effects. This paper presents the latest dynamic nanoassemblies for effective PDT or PTT and combination phototherapies, including immunotherapy and image-guided therapy. Dynamic self-assembly exhibits great potential for clinical translation in diagnosis and treatment through its integrated versatility. Nanoassemblies based on multidisciplinary technology are a promising technique for treating incurable cancerous diseases in the future.
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Affiliation(s)
- Hayoon Jeong
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, 43 Jibong-ro, Bucheon, Gyeonggi 14662, Republic of Korea; Department of Biotechnology, The Catholic University of Korea, 43 Jibong-ro, Bucheon, Gyeonggi 14662, Republic of Korea
| | - Wooram Park
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, 43 Jibong-ro, Bucheon, Gyeonggi 14662, Republic of Korea; Department of Biotechnology, The Catholic University of Korea, 43 Jibong-ro, Bucheon, Gyeonggi 14662, Republic of Korea
| | - Dong-Hyun Kim
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; Robert H. Lurie Comprehensive Cancer Center, Chicago, IL 60611, USA; Department of Biomedical Engineering, McCormick School of Engineering, Evanston, IL 60208, USA; Department of Bioengineering, The University of Illinois at Chicago, Chicago, IL 60607, USA.
| | - Kun Na
- Department of Biomedical-Chemical Engineering, The Catholic University of Korea, 43 Jibong-ro, Bucheon, Gyeonggi 14662, Republic of Korea; Department of Biotechnology, The Catholic University of Korea, 43 Jibong-ro, Bucheon, Gyeonggi 14662, Republic of Korea.
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13
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Gómez Ochoa P, Alférez MD, de Blas I, Fernendes T, Sánchez Salguero X, Balañá B, Meléndez Lazo A, Barbero Fernandez A, Caivano D, Corda F, Corda A. Ultrasound-Guided Radiofrequency Ablation of Chemodectomas in Five Dogs. Animals (Basel) 2021; 11:2790. [PMID: 34679812 PMCID: PMC8532905 DOI: 10.3390/ani11102790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/17/2021] [Accepted: 09/20/2021] [Indexed: 11/17/2022] Open
Abstract
Chemodectomas are low prevalence tumors with complex clinical management. Many present as an incidental finding however, in other dogs, they produce pericardial effusion and/or compression, leading to the appearance of severe clinical signs. There are currently several approaches: surgery, radiotherapy, stent placement and chemotherapy. This is the first description of percutaneous echo-guided radiofrequency ablation of aortic body tumors. This minimally invasive treatment is based on high frequency alternating electrical currents from an electrode that produces ionic agitation and generates frictional heat, causing coagulation necrosis. Five dogs with an echocardiographic and cytological diagnosis of chemodectoma underwent percutaneous echo-guided radiofrequency ablation. At the time of presentation, all the dogs showed clinical signs, such as ascites and/or collapse. There were no complications either during the procedure or in the following 24 hours. Rapid clinical improvement associated with a reduction in size and change in sonographic appearance of the mass were achieved with no complications. Six months follow-up was carried out in all dogs. A second percutaneous echo-guided RFA was performed eight months after the first procedure in one dog. Based on our experience, radiofrequency ablation seems to be a feasible and safe technique, making it a potential alternative therapeutic approach in the clinical management of aortic body tumors leading to severe clinical compromise.
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Affiliation(s)
- Pablo Gómez Ochoa
- VetCorner, 50012 Zaragoza, Spain;
- Department of Animal Pathology, University of Zaragoza, 50013 Zaragoza, Spain;
| | | | - Ignacio de Blas
- Department of Animal Pathology, University of Zaragoza, 50013 Zaragoza, Spain;
| | - Telmo Fernendes
- Imaginologia Veterinaria do Porto, 4490-479 Porto, Portugal;
| | - Xavier Sánchez Salguero
- Department of Animal Science, School of Agriculture, Food Science and Veterinary Medicine (ETSEA), University of Lleida, 25198 Lleida, Spain;
| | - Beatriz Balañá
- Hospital Aralar Veterinarios, Cuarte de Huerva, 50410 Zaragoza, Spain;
| | | | - Alicia Barbero Fernandez
- Department of Veterinary Medicine, University Alfonso X el Sabio, Villanueva de la Cañada, 28691 Madrid, Spain;
| | - Domenico Caivano
- Department of Veterinary Medicine, University of Perugia, 06126 Perugia, Italy
| | - Francesca Corda
- Department of Veterinary Medicine, University of Sassari, 07100 Sassari, Italy; (F.C.); (A.C.)
| | - Andrea Corda
- Department of Veterinary Medicine, University of Sassari, 07100 Sassari, Italy; (F.C.); (A.C.)
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14
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Majeed NF, Braschi Amirfarzan M, Wald C, Wortman JR. Spectral detector CT applications in advanced liver imaging. Br J Radiol 2021; 94:20201290. [PMID: 34048285 PMCID: PMC8248211 DOI: 10.1259/bjr.20201290] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/16/2021] [Accepted: 05/13/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Spectral detector CT (SDCT) has many applications in advanced liver imaging. If appropriately utilized, this technology has the potential to improve image quality, provide new diagnostic information, and allow for decreased radiation dose. The purpose of this review is to familiarize radiologists with the uses of SDCT in liver imaging. CONCLUSION SDCT has a variety of post-processing techniques, which can be used in advanced liver imaging and can significantly add value in clinical practice.
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Affiliation(s)
- Noor Fatima Majeed
- Department of Radiology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, United States
| | - Marta Braschi Amirfarzan
- Department of Radiology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, United States
| | - Christoph Wald
- Department of Radiology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, United States
| | - Jeremy R Wortman
- Department of Radiology, Lahey Hospital and Medical Center, 41 Burlington Mall Road, Burlington, United States
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15
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Histological Correlation for Radiofrequency and Microwave Ablation in the Local Control of Hepatocellular Carcinoma (HCC) before Liver Transplantation: A Comprehensive Review. Cancers (Basel) 2020; 13:cancers13010104. [PMID: 33396289 PMCID: PMC7795634 DOI: 10.3390/cancers13010104] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 02/06/2023] Open
Abstract
Simple Summary Liver cancer is a growing problem around the world. Drugs for liver cancer have limited effect, there are not enough donors for liver transplants and many patients are not candidates for surgery to remove the tumor. In many of these cases, hyperthermia can destroy the tumor in situ with minimally invasive methods such as radiofrequency or microwave ablation. In this paper we review the literature evaluating success rates for complete ablation as judged by actual examination of treated tumors that were removed when patients received a liver transplant. While notable successes can be achieved with ablation, the published studies indicate both that complete treatment is not as common as thought and that imaging methods such as computed tomography and magnetic resonance scans do not completely identify residual cancer. There is therefore an important opportunity for improvement in the treatment of this disease. Abstract Radiofrequency ablation (RFA) and microwave ablation (MWA) are the most widely studied and applied ablation techniques for treating primary and secondary liver tumors. These techniques are considered curative for small hepatic tumors, with post-ablation outcomes most commonly assessed by an imaging follow up. However, there is increasing evidence of a discrepancy between radiological and pathological findings when ablated lesions are evaluated following liver resection or liver transplantation. A comprehensive review of the available literature reporting the complete pathological response (cPR) following RFA and MWA was performed to estimate the success rate and identify the factors associated with treatment failure. Following RFA, cPR is reported in 26–96% of tumors compared to 57–95% with MWA. Larger tumor size and vessels larger than 3 mm adjacent to the treated tumor are the most important factors identified by previous studies associated with viable residual tumors after RFA. Correlating post-ablation radiological studies with pathological findings shows that computed tomography (CT) and magnetic resonance imaging (MRI) have low sensitivity but high specificity for detecting residual viable or recurrent hepatocellular carcinoma (HCC) tumors. There are promising recent reports combining multiprobe ablation techniques with three-dimensional treatment planning software and stereotactic-aiming instrumentation to achieve more than 90% cPR in both small and large HCC tumors. In conclusion, the reported success for achieving cPR in HCC following RFA and MWA is highly variable in different studies and decreases with increasing lesion size and unfavorable tumor characteristics. Very few studies have reported a high rate of cPR. As these studies are single-center and retrospective, they need to be further validated and reproduced in other clinical settings.
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Arellano RS. What's New in Percutaneous Ablative Strategies for Hepatocellular Carcinoma and Colorectal Hepatic Metastases? 2020 Update. Curr Oncol Rep 2020; 22:105. [PMID: 32725433 DOI: 10.1007/s11912-020-00967-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PURPOSE OF REVIEW Ablation techniques are now well-established treatment options available for the management of primary and secondary hepatic malignancies. Currently available ablative techniques include radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation, and irreversible electroporation (IRE). Along with advances in navigational devices and targeting technologies, ablation combined with other therapies may be the next therapeutic option in thermal ablation. The purpose of this review is to evaluate the current status of ablative technologies in interventional and medical oncology for management of liver malignancies. RECENT FINDINGS With the use of combination techniques (i.e., ablation and transarterial embolization procedures), thermal ablation is now moving toward treating tumors larger than 3 cm in size or tumors with macrovascular invasion. Ongoing trials are examining the optimum timing of combination therapies. Thermal ablation combined with hepatic resection may increase the number of patients with metastatic colorectal carcinoma to the liver who qualify for curative surgery. Combination therapies of thermal ablation and transarterial embolization allow for promising treatment responses for larger HCC. Surgery combined with thermal ablation can potentially increase the number of patients with metastatic colon cancer to the liver who qualify for curative surgery.
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Affiliation(s)
- Ronald S Arellano
- Division of Interventional Radiology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit Street, GRB 293, Boston, MA, 02114, USA.
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17
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Abstract
Renal cell carcinoma is most commonly diagnosed in the sixth or seventh decade of life. Historically, surgical extirpation was the gold standard treatment option for small renal masses. However, given the comorbidities in this elderly population, not all patients are candidates for surgery. The development of minimally invasive ablative therapies has solved the surgical dilemma in this patient population. Furthermore, the 2017 American Urological Association guidelines recommends consideration of percutaneous image guided thermal ablation as a treatment option for masses smaller than 3 cm even in healthy individuals. Percutaneous image guided thermal ablation is an attractive treatment option providing excellent local tumor control, fewer complications, better preservation of the renal functions, faster recovery and shorter hospital stay. Various ablative modalities are available in clinical practice. This includes radiofrequency ablation, cryoablation, microwave ablation, irreversible electroporation, high intensity focused ultrasound, and laser ablation. In this review, we focus on the most commonly used modalities including radiofrequency ablation and cryoablation and to a lesser extent microwave ablation and irreversible electroporation.
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Affiliation(s)
- Mohamed E Abdelsalam
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Kamran Ahrar
- Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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18
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Patil PG, Reddy P, Rawat S, Ananthasivan R, Sinha R. Multimodality Approach in Detection and Characterization of Hepatic Metastases. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2020. [DOI: 10.1055/s-0039-3402100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
AbstractEarly detection of liver metastases is important in patients with known primary malignancies. This plays an important role in treatment planning and impacts on further management of certain primary malignancies.Magnetic resonance imaging (MRI), computed tomography (CT), and positron emission tomography-computed tomography scans are reported to have high accuracy in the diagnosis of intrahepatic lesions. MRI in particular has the advantages of its high tissue sensitivity and its multiparametric approach.Hepatic metastatic lesions have considerable overlap in their radiological appearance, and in this article the imaging appearance of various hepatic metastasis and approach is described.
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Affiliation(s)
- Pooja G. Patil
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Pramesh Reddy
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Sudarshan Rawat
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Rupa Ananthasivan
- Department of Radiology, Manipal Hospital, Bangalore, Karnataka, India
| | - Rakesh Sinha
- Department of Radiology, South Warwickshire NHS Foundation Trust, Warwick, United Kingdom
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19
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De Filippo M, Ziglioli F, Russo U, Pagano P, Brunese L, Bertelli E, Pagnini F, Maestroni U. Radiofrequency ablation (RFA) of T1a renal cancer with externally cooled multitined expandable electrodes. Radiol Med 2020; 125:790-797. [PMID: 32206984 DOI: 10.1007/s11547-020-01175-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 03/11/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To retrospectively evaluate the mid-term outcomes of percutaneous radiofrequency ablation (RFA) with multitined expandable electrodes externally cooled with saline solution in patients with T1a renal cell carcinoma (RCC). MATERIALS AND METHODS In this retrospective study, we evaluated 39 RCC in 35 patients treated with CT-guided RFA in 41 procedures (2011-2017). All patients were staged T1a, N0, M0 prior to RFA. Mean tumor size was 24.48 mm. A 4-tined expandable RFA electrode cooled with pump-circulating saline was used. Efficacy was evaluated verifying complete tumor necrosis (no contrast enhancement on imaging) at the end of the procedure and on subsequent controls. Follow-up observation period was 5 years. Minor/major complications, hospitalization days, serum creatinine and GFR pre- and post-RFA (compared using paired t test) and post-operative pain (evaluated with NRS after treatment) were considered as safety indicators. Overall survival was also calculated (Kaplan-Meier method). RESULTS Of 35 patients, 30/35 had 1 treatment (primary effectiveness rate 86%), 4/35 had 2 treatments and 1/35 had 3 treatments for residual disease. There were no relapses and no mid-long-term complications; 3 minor (8%) and 1 major (2.7%) complications during perioperative period were reported. Mean before and after RFA serum creatinine rates were, respectively, 1.08 mg/dl and 1.11 mg/dl (p value: 0.4117). NRS median value is 0.8. Hospitalization days median value is [2.8 ± 1.9] days. 91.4% of all patients survived, with a median overall survival time of 65 months. CONCLUSIONS Mid-term results show that CT-guided RFA with multitined expandable electrodes externally cooled with saline solution is an effective and safe treatment in patients with RCC-staged T1aN0M0. Data reported in our study are in line with data reported in the literature from patients treated with other devices.
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Affiliation(s)
- Massimo De Filippo
- Department of Medicine and Surgery, Unit of Radiology, University of Parma, Via Gramsci 14, Parma, Italy.
| | - Francesco Ziglioli
- Department of Surgery, Unit of Urology, University-Hospital of Parma, Via Gramsci 14, Parma, Italy
| | - Umberto Russo
- Department of Medicine and Surgery, Unit of Radiologic Sciences, University-Hospital of Parma, Via Gramsci 14, Parma, Italy
| | - Paolo Pagano
- Department of Medicine and Surgery, Unit of Radiologic Sciences, University-Hospital of Parma, Via Gramsci 14, Parma, Italy
| | - Luca Brunese
- Department of Medicine and Health Science, University of Molise, Via Francesco De Santis 86, Campobasso, Italy
| | - Elena Bertelli
- Department of Radiology, University-Hospital of Careggi, Largo Brambilla 3, Florence, Italy
| | - Francesco Pagnini
- Department of Medicine and Surgery, Unit of Radiology, University of Parma, Via Gramsci 14, Parma, Italy
| | - Umberto Maestroni
- Department of Surgery, Unit of Urology, University-Hospital of Parma, Via Gramsci 14, Parma, Italy
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20
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Lin XL, Hai N, Zhang J, Han ZY, Yu J, Liu FY, Dong XJ, Liang P. Comparison between microwave ablation and radiofrequency ablation for treating symptomatic uterine adenomyosis. Int J Hyperthermia 2020; 37:151-156. [PMID: 32024402 DOI: 10.1080/02656736.2019.1708481] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Xiao Liang Lin
- Department of Interventional Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ning Hai
- Department of Ultrasound, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Interventional Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Zhi Yu Han
- Department of Interventional Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jie Yu
- Department of Interventional Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Fang Yi Liu
- Department of Interventional Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Xue Juan Dong
- Department of Interventional Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Ping Liang
- Department of Interventional Ultrasound, The First Medical Center, Chinese PLA General Hospital, Beijing, China
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21
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Mendiratta-Lala M, Masch WR, Shampain K, Zhang A, Jo AS, Moorman S, Aslam A, Maturen KE, Davenport MS. MRI Assessment of Hepatocellular Carcinoma after Local-Regional Therapy: A Comprehensive Review. Radiol Imaging Cancer 2020; 2:e190024. [PMID: 33778692 DOI: 10.1148/rycan.2020190024] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 07/29/2019] [Accepted: 09/10/2019] [Indexed: 12/13/2022]
Abstract
Nearly 80% of cirrhotic patients diagnosed with hepatocellular carcinoma (HCC) are not eligible for surgical resection and instead undergo local-regional treatment. After therapy for HCC, patients undergo imaging surveillance to assess treatment efficacy and identify potential sites of progressive tumor elsewhere within the liver. Accurate interpretation of posttreatment imaging is essential for guiding further management decisions, and radiologists must understand expected treatment-specific imaging findings for each of the local-regional therapies. Of interest, expected imaging findings seen after radiation-based therapies (transarterial radioembolization and stereotactic body radiation therapy) are different than those seen after thermal ablation and transarterial chemoembolization. Given differences in expected posttreatment imaging findings, the current radiologic treatment response assessment algorithms used for HCC (modified Response Evaluation Criteria in Solid Tumors classification, European Association for the Study of Liver Diseases criteria, and Liver Imaging and Reporting Data System Treatment Response Algorithm) must be applied cautiously for radiation-based therapies in which persistent arterial phase hyperenhancement in the early posttreatment period is common and expected. This article will review the concept of tumor response assessment for HCC, the forms of local-regional therapy for HCC, and the expected posttreatment findings for each form of therapy. Keywords: Abdomen/GI, Liver, MR-Imaging, Treatment Effects, Tumor Response © RSNA, 2020.
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Affiliation(s)
- Mishal Mendiratta-Lala
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - William R Masch
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - Kimberly Shampain
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - Andrew Zhang
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - Alexandria S Jo
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - Sarah Moorman
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - Anum Aslam
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - Katherine E Maturen
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
| | - Matthew S Davenport
- Department of Radiology, University of Michigan Health System, 1500 E Medical Center Dr, UH B2A209R, Ann Arbor, MI 48109-5030
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22
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He J, Li CL, Wilson BC, Fisher CJ, Ghai S, Weersink RA. A Clinical Prototype Transrectal Diffuse Optical Tomography (TRDOT) System for In vivo Monitoring of Photothermal Therapy (PTT) of Focal Prostate Cancer. IEEE Trans Biomed Eng 2019; 67:2119-2129. [PMID: 31765300 DOI: 10.1109/tbme.2019.2955354] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We describe the rationale, design, fabrication and performance of a clinical transrectal diffuse optical tomography (TRDOT) system for in vivo monitoring of photothermal therapy (PTT) of localized prostate cancer. The system comprises a 32-channel fiberoptic-based, MRI-compatible transrectal probe connected to a computer-controlled instrument that includes laser diode sources, an optical fiber switch and photomultiplier tube detectors. Performance tests were performed in tissue-simulating phantoms and in ex vivo muscle tissue during PTT treatment. The safety and technical feasibility of in vivo transrectal use were tested in a canine prostate model and in a first-in-human study in a patient before PTT treatment. Limitations of the system are discussed, as well as further developments to translate it into planned clinical trials for monitoring the photocoagulation boundary in the prostate during PTT.
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23
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Guo LH, Wang D, Li XL, Liu BJ, Chen S, Li DD, Xu HX. Stiffness distribution in the ablated zone after radiofrequency ablation for liver: An ex-vivo study with a tissue elastometer. Clin Hemorheol Microcirc 2019; 72:151-160. [PMID: 30689559 DOI: 10.3233/ch-180404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Le-Hang Guo
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Nanjing Medical University, Shanghai, China
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Dan Wang
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Xiao-Long Li
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Bo-Ji Liu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Shigao Chen
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Dan-Dan Li
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
| | - Hui-Xiong Xu
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Nanjing Medical University, Shanghai, China
- Department of Medical Ultrasound, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
- Ultrasound Research and Education Institute, Tongji University School of Medicine, Shanghai, China
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Su L, Tian W, Xu M, Lin M, Zhuang B, Huang T, Ye J, Lv M, Xie X. Performance of Shear Wave Elastography in Delineating the Radiofrequency Ablation Boundary: An in Vivo experiment. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1324-1330. [PMID: 30851952 DOI: 10.1016/j.ultrasmedbio.2019.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 01/13/2019] [Accepted: 01/16/2019] [Indexed: 06/09/2023]
Abstract
This study was aimed at exploring the cutoff value of Young's modulus of ablated tissue and the optimal scale at which shear wave elastography (SWE) can delineate the ablation boundary. The livers of 30 rabbits were radiofrequency (RF) ablated, and ultrasonic imaging, including SWE and contrast-enhanced ultrasound (CEUS), was performed. The ablation boundary in the SWE image was located using CEUS, and the SWE parameters of the boundary were measured to calculate the cutoff value of Young's modulus. The cutoff value of the ablated tissue was 48-50 kPa 2 h to 28 d post-ablation. The regions of increased stiffness in SWE images at a scale of 0-50 kPa overlapped well with the non-enhanced regions of CEUS images in 88% of specimens. Therefore, elasticity values differed significantly between ablated and non-ablated tissues, and the cutoff value for Young's modulus differentiated these tissues. SWE delineated the ablation boundary well at the optimal SWE scale with respect to the cutoff value.
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Affiliation(s)
- Liya Su
- Department of Medical Ultrasound, First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China
| | - Wenshuo Tian
- Department of Medical Ultrasound, First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China
| | - Ming Xu
- Department of Medical Ultrasound, First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China
| | - Manxia Lin
- Department of Medical Ultrasound, First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China
| | - Bowen Zhuang
- Department of Medical Ultrasound, First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China
| | - Tongyi Huang
- Department of Medical Ultrasound, First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China
| | - Jieyi Ye
- Department of Medical Ultrasound, First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China
| | - Mingde Lv
- Department of Medical Ultrasound, First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoyan Xie
- Department of Medical Ultrasound, First Affiliated Hospital, Institute of Diagnostic and Interventional Ultrasound, Sun Yat-Sen University, Guangzhou, China.
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Sotirchos VS, Fujisawa S, Vakiani E, Solomon SB, Manova-Todorova KO, Sofocleous CT. Fluorescent Tissue Assessment of Colorectal Cancer Liver Metastases Ablation Zone: A Potential Real-Time Biomarker of Complete Tumor Ablation. Ann Surg Oncol 2019; 26:1833-1840. [PMID: 30830537 DOI: 10.1245/s10434-018-07133-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study aimed to evaluate whether rapid fluorescent tissue examination immediately after colorectal cancer liver metastasis (CLM) ablation correlates with standard pathologic and immunohistochemical (IHC) assessments. METHODS This prospective, National Institutes of Health-supported study enrolled 34 consecutive patients with 53 CLMs ablated between January 2011 and December 2014. Immediately after ablation, core needle sampling of the ablation zone was performed. Tissue samples were evaluated with fluorescent viability (MitoTracker Red) and nuclear (Hoechst) stains. Confocal microscope imaging was performed within 30 min after ablation. The same samples were subsequently fixed and stained with hematoxylin and eosin (H&E). Identified tumor cells underwent IHC staining for proliferation (Ki67) and viability (OxPhos). The study pathologist, blinded to the H&E and IHC assessment, evaluated the fluorescent images separately to detect viable tumor cells. Sensitivity, specificity, and overall concordance of the fluorescent versus H&E and IHC assessments were calculated. RESULTS A total of 63 tissue samples were collected and processed. The overall concordance rate between the immediate fluorescent and the subsequent H&E and IHC assessments was 94% (59/63). The fluorescent assessment sensitivity and specificity for the identification of tumor cells were respectively 100% (18/18) and 91% (41/45). CONCLUSIONS The study showed a high concordance rate between the immediate fluorescent assessment and the standard H&E and IHC assessment of the ablation zone. Given the documented prognostic value of ablation zone tissue characteristics for outcomes after ablation of CLM, the fluorescent assessment offers a potential intra-procedural biomarker of complete tumor ablation.
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Affiliation(s)
- Vlasios S Sotirchos
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - Sho Fujisawa
- Molecular Cytology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Efsevia Vakiani
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen B Solomon
- Interventional Radiology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Beisenova A, Issatayeva A, Sovetov S, Korganbayev S, Jelbuldina M, Ashikbayeva Z, Blanc W, Schena E, Sales S, Molardi C, Tosi D. Multi-fiber distributed thermal profiling of minimally invasive thermal ablation with scattering-level multiplexing in MgO-doped fibers. BIOMEDICAL OPTICS EXPRESS 2019; 10:1282-1296. [PMID: 30891346 PMCID: PMC6420269 DOI: 10.1364/boe.10.001282] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 05/03/2023]
Abstract
We propose a setup for multiplexed distributed optical fiber sensors capable of resolving temperature distribution in thermo-therapies, with a spatial resolution of 2.5 mm over multiple fibers interrogated simultaneously. The setup is based on optical backscatter reflectometry (OBR) applied to optical fibers having backscattered power significantly larger than standard fibers (36.5 dB), obtained through MgO doping. The setup is based on a scattering-level multiplexing, which allows interrogating all the sensing fibers simultaneously, thanks to the fact that the backscattered power can be unambiguously associated to each fiber. The setup has been validated for the planar measurement of temperature profiles in ex vivo radiofrequency ablation, obtaining the measurement of temperature over a surface of 96 total points (4 fibers, 8 sensing points per cm2). The spatial resolution obtained for the planar measurement allows extending distributed sensing to surface, or even three-dimensional, geometries performing temperature sensing in the tissue with millimeter resolution in multiple dimensions.
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Affiliation(s)
- Aidana Beisenova
- Nazarbayev University, Department of Electrical and Computer Engineering, 010000 Astana, Kazakhstan
| | - Aizhan Issatayeva
- Nazarbayev University, Department of Electrical and Computer Engineering, 010000 Astana, Kazakhstan
| | - Sultan Sovetov
- Nazarbayev University, Department of Electrical and Computer Engineering, 010000 Astana, Kazakhstan
| | - Sanzhar Korganbayev
- Laboratory of Biosensors and Bioinstruments, National Laboratory Astana, 010000 Astana, Kazakhstan
| | - Madina Jelbuldina
- Nazarbayev University, Department of Electrical and Computer Engineering, 010000 Astana, Kazakhstan
- Laboratory of Biosensors and Bioinstruments, National Laboratory Astana, 010000 Astana, Kazakhstan
| | - Zhannat Ashikbayeva
- Nazarbayev University, Department of Electrical and Computer Engineering, 010000 Astana, Kazakhstan
- Laboratory of Biosensors and Bioinstruments, National Laboratory Astana, 010000 Astana, Kazakhstan
| | - Wilfried Blanc
- Université Côte d’Azur, INPHYNI–CNRS UMR 7010, Parc Valrose, 06108 Nice, France
| | - Emiliano Schena
- E. Unit of Measurements and Biomedical Instrumentation, University Campus Bio-Medico of Rome, via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Salvador Sales
- Institute of Telecommunications and Multimedia Applications (iTEAM), Universitat Politècnica de València, Camino de Vera s/n, 46022 Valencia, Spain
| | - Carlo Molardi
- Nazarbayev University, Department of Electrical and Computer Engineering, 010000 Astana, Kazakhstan
| | - Daniele Tosi
- Nazarbayev University, Department of Electrical and Computer Engineering, 010000 Astana, Kazakhstan
- Laboratory of Biosensors and Bioinstruments, National Laboratory Astana, 010000 Astana, Kazakhstan
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Tumefactive Fat Necrosis with Multinucleate Giant Cell Reaction Mimicking Recurrent Renal Cell Carcinoma following Percutaneous Renal Cryoablation. Case Rep Urol 2019; 2019:1678193. [PMID: 30937210 PMCID: PMC6413368 DOI: 10.1155/2019/1678193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/11/2019] [Indexed: 12/18/2022] Open
Abstract
Multinucleate Giant Cell (GC) reaction is a biological response that occurs secondary to infection, an implanted foreign body, tissue injury, or inflammation. In rare instances GC reactions have been reported following tissue ablation. Multinucleate GC reactions and tumefactive fat necrosis both have the ability to mimic cancer recurrence or metastasis and can appear as enhancing masses. We discuss a case of a surgically resected retroperitoneal perinephric mass thought to be recurrent renal cell carcinoma (RCC) that was pathologically confirmed as tumefactive fat necrosis with multinucleate GC reaction 2 years following percutaneous cryoablation of a small renal mass.
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28
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Lee DH, Lee JM, Kim PN, Jang YJ, Kang TW, Rhim H, Seo JW, Lee YJ. Whole tumor ablation of locally recurred hepatocellular carcinoma including retained iodized oil after transarterial chemoembolization improves progression-free survival. Eur Radiol 2019; 29:5052-5062. [PMID: 30770968 DOI: 10.1007/s00330-018-5993-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 12/05/2018] [Accepted: 12/28/2018] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate and compare clinical outcomes of two different radiofrequency ablation (RFA) methods for locally recurred hepatocellular carcinoma (LrHCC) after locoregional treatment. METHODS Our institutional review board approved this study with a waiver of informed consent. A total of 313 patients previously treated with transarterial chemoembolization (TACE) (n = 167) and RFA (n = 146) with a single LrHCC ≤ 3 cm was included from five tertiary referral hospitals. RFA was done for LrHCCs using either viable tumor alone ablation (VTA) method (VTA: n = 61 in the TACE group and n = 127 in the RFA group) or whole tumor ablation (WTA) method which includes both viable tumor and retained iodized oil or previously ablated zone (WTA: n = 106 in the TACE group and n = 19 in the RFA group). Local tumor progression (LTP)-free survival as well as progression-free survival (PFS) were estimated using the Kaplan-Meier method, and prognostic factors were evaluated using the Cox proportional hazards regression model. RESULTS In 167 patients with LrHCC who underwent TACE, the 5-year LTP-free survival after RFA was significantly higher with the VTA method than with the WTA method (26.9% vs. 87.8%; p < 0.001; hazard ratio (HR) = 8.53 [4.16-17.5]). The estimated 5-year PFS after RFA for LrHCC after TACE using the VTA method was 5.7%, which was significantly lower than that with the WTA method (26.4%) (p = 0.014; HR = 1.62 [1.10-2.38]). However, in 146 patients with LrHCC after initial RFA, there were no significant differences in cumulative incidence of LTP (p = 0.514) or PFS (p = 0.905) after RFA between the two ablation methods. CONCLUSIONS For RFA of LrHCC after TACE, the WTA method including both viable tumor and retained iodized oil could significantly lower LTP and improve PFS than VTA. KEY POINTS • Whole tumor ablation (WTA) could provide significantly better local tumor control for locally recurred HCC (LrHCC) after TACE than viable tumor alone ablation (VTA). • WTA for LrHCC after TACE could also provide significantly better progression-free survival than VTA. • Regarding LrHCC after RFA, VTA would provide a comparable clinical outcome to WTA.
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Affiliation(s)
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehangno, Jongno-gu, Seoul, 110-744, South Korea. .,Institute of Radiation Medicine, College of Medicine, Seoul National University, Seoul, South Korea.
| | - Pyo Nyun Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan, Asan Medical Center, Seoul, South Korea
| | - Yun-Jin Jang
- Department of Radiology and Research Institute of Radiology, University of Ulsan, Asan Medical Center, Seoul, South Korea
| | - Tae Wook Kang
- Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Hyunchul Rhim
- Department of Radiology, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea
| | - Jung Wook Seo
- Department of Radiology, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Young Joon Lee
- Department of Radiology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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29
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Jiang AN, Wang S, Yang W, Zhao K, Bai XM, Zhang ZY, Wu W, Chen MH, Yan K. The Role of a Curved Electrode with Controllable Direction in the Radiofrequency Ablation of Liver Tumors Behind Large Vessels. Cardiovasc Intervent Radiol 2019; 42:893-904. [PMID: 30761411 DOI: 10.1007/s00270-019-02182-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 02/05/2019] [Indexed: 01/16/2023]
Abstract
PURPOSE To investigate the role of a novel curved radiofrequency ablation (RFA) electrode with controllable direction in the ablation of tumors behind large hepatic vessels in ex vivo bovine and in vivo canine liver experiments. MATERIALS AND METHODS Approval from the institutional animal care and use committee was obtained. In ex vivo experiments, conventional multi-tines expandable electrodes, conventional monopolar straight electrodes and novel curved electrodes were used in the ablation of the bovine liver (n = 90). The ablated area, parallel axis, vertical axis and shape of different electrodes were compared. Then, 24 beagle dogs (10 months old, female) were used for in vivo experiments. Visual tumor targets deeply located in the portal vein were established, and ultrasound-guided liver ablation was performed with different electrodes. The ablation range, target coverage rate, percentage of normal tissue injury and damage to adjacent vessels were evaluated. The Kruskal-Wallis test and the Chi-squared test were used for statistical analysis. RESULTS For the ex vivo study with a 3-cm electrode, the ablation area of the multi-tines expandable electrode group (7.14 ± 0.16 cm2) was significantly larger than that of the novel curved electrode group (5.01 ± 0.30 cm2, P < 0.001) and the monopolar straight electrode group (5.43 ± 0.15 cm2, P < 0.001). The results obtained with the 4-cm electrode in the three groups were in accordance with those of the 3-cm electrode. In vivo, the normal tissue damage area of the novel curved electrode group was smaller than that of the multi-tines expandable electrode group (1.10 ± 0.18 cm2 vs. 4.00 ± 0.18 cm2, P < 0.001). The target coverage rate of the novel curved electrode group was better than that of the monopolar straight electrode group (100% vs. 80.86 ± 1.68%, P < 0.001). The hematoxylin and eosin (H&E) and TUNEL staining results showed that the ablation necrosis area was adjacent to large vessels, but the vascular wall was not significantly damaged in the novel curved electrode group. CONCLUSION Our preliminary results showed that the novel curved RFA electrode with controllable direction could achieve accurate ablation for tumors behind large hepatic vessels, with a better target coverage rate and less damage to normal tissue, than conventional multi-tines expandable electrodes and monopolar straight electrodes.
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Affiliation(s)
- An-Na Jiang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Song Wang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Wei Yang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China.
| | - Kun Zhao
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Xiu-Mei Bai
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Zhong-Yi Zhang
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Wei Wu
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Min-Hua Chen
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
| | - Kun Yan
- Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Peking University Cancer Hospital and Institute, 52 Fucheng Road, Haidian District, Beijing, 100142, China
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30
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Francica G, Meloni MF, Riccardi L, de Sio I, Terracciano F, Caturelli E, Iadevaia MD, Amoruso A, Roselli P, Chiang J, Scaglione M, Pompili M. Ablation treatment of primary and secondary liver tumors under contrast-enhanced ultrasound guidance in field practice of interventional ultrasound centers. A multicenter study. Eur J Radiol 2018; 105:96-101. [DOI: 10.1016/j.ejrad.2018.05.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 05/25/2018] [Accepted: 05/29/2018] [Indexed: 12/21/2022]
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31
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Young S, Taylor AJ, Sanghvi T. Post Locoregional Therapy Treatment Imaging in Hepatocellular Carcinoma Patients: A Literature-based Review. J Clin Transl Hepatol 2018; 6:189-197. [PMID: 29951364 PMCID: PMC6018307 DOI: 10.14218/jcth.2017.00059] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 12/14/2017] [Accepted: 12/22/2017] [Indexed: 12/19/2022] Open
Abstract
Imaging plays a crucial role in the diagnosis of hepatocellular carcinoma (HCC) as well as in determining treatment efficacy, or complications, following therapy. Unlike other cancers, HCC is most commonly treated by locoregional therapies (LRTs) such as thermal ablation, transarterial chemoembolization, and transarterial radioembolization. These treatments can lead to changes on imaging that make determination of residual/recurrent disease difficult. This literature-based review discusses the expected postimaging findings following LRT.
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Affiliation(s)
- Shamar Young
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Andrew J. Taylor
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
- *Correspondence to: Andrew J. Taylor, Department of Radiology, University of Minnesota, 420 Delaware Street SE, MMC 292, Minneapolis, MN 55455, USA. Tel: +1-612-626-6638, Fax: +1-612-626-5505, E-mail:
| | - Tina Sanghvi
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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Scheck J, Bruners P, Schindler D, Kuhl C, Isfort P. Comparison of Chronologic Change in the Size and Contrast-Enhancement of Ablation Zones on CT Images after Irreversible Electroporation and Radiofrequency Ablation. Korean J Radiol 2018; 19:560-567. [PMID: 29962862 PMCID: PMC6005936 DOI: 10.3348/kjr.2018.19.4.560] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Accepted: 12/18/2017] [Indexed: 12/18/2022] Open
Abstract
Objective To compare short-, mid-, and long-term follow-up ablation zone volume alterations as well as imaging features on contrast-enhanced computed tomography (CT) after irreversible electroporation (IRE) of primary and secondary liver tumors with findings subsequent to radiofrequency ablation (RFA). Materials and Methods Volume assessment of 39 ablation zones (19 RFA, 20 IRE) after intervention was performed at four time intervals (day 0 [t1; n = 39], day 1-7 [t2; n = 25], day 8-55 [t3; n = 28], after day 55 [t4; n = 23]) on dual-phase CT. Analysis of peripheral rim enhancement was conducted. Lesion's volume decrease relative to the volume at t1 was calculated and statistically analyzed with respect to patient's sex, age, ablation modality (IRE/RFA), and history of platinum-based chemotherapy (PCT). Results No influence of patient's sex or age on ablation volume was detected. The decrease in ablation zones' volume was significantly larger (p < 0.05 for all time intervals) after IRE (arterial phase, 7.5%; venous phase, 9.7% of initial volume) compared to RFA (arterial phase, 39.6%; venous phase, 45.3% of initial volume). After RFA, significantly smaller decreases in the ablation volumes, in general, were detected in patients treated with PCT in their history (p = 0.004), which was not detected after IRE (p = 0.288). In the arterial phase, peripheral rim enhancement was frequently detected after both IRE and RFA. In the venous phase, rim-enhancement was depicted significantly more often following IRE at t1 and t2 (pt1 = 0.003, pt2 < 0.001). Conclusion As per our analysis, ablation zone volume decreased significantly in a more rapid and more profound manner after IRE. Lesion's remodeling after RFA but not IRE seems to be influenced by PCT, possibly due to the type of cell death induced by the different ablation modalities.
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Affiliation(s)
- Jonas Scheck
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, RWTH Aachen University, Aachen 52074, Germany
| | - Philipp Bruners
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, RWTH Aachen University, Aachen 52074, Germany
| | - David Schindler
- Institute of Medical Statistics, Aachen University Hospital, RWTH Aachen University, Aachen 52074, Germany
| | - Christiane Kuhl
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, RWTH Aachen University, Aachen 52074, Germany
| | - Peter Isfort
- Department of Diagnostic and Interventional Radiology, Aachen University Hospital, RWTH Aachen University, Aachen 52074, Germany
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Arellano RS. Ablation of Renal Cell Carcinoma: An Assessment of Currently Available Techniques. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jradnu.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Hue YK, Guimaraes AR, Cohen O, Nevo E, Roth A, Ackerman JL. Magnetic Resonance Mediated Radiofrequency Ablation. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:417-427. [PMID: 28922117 PMCID: PMC5813696 DOI: 10.1109/tmi.2017.2753739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
To introduce magnetic resonance mediated radiofrequency ablation (MR-RFA), in which the MRI scanner uniquely serves both diagnostic and therapeutic roles. In MR-RFA scanner-induced RF heating is channeled to the ablation site via a Larmor frequency RF pickup device and needle system, and controlled via the pulse sequence. MR-RFA was evaluated with simulation of electric and magnetic fields to predict the increase in local specific-absorption-rate (SAR). Temperature-time profiles were measured for different configurations of the device in agar phantoms and ex vivo bovine liver in a 1.5 T scanner. Temperature rise in MR-RFA was imaged using the proton resonance frequency method validated with fiber-optic thermometry. MR-RFA was performed on the livers of two healthy live pigs. Simulations indicated a near tenfold increase in SAR at the RFA needle tip. Temperature-time profiles depended significantly on the physical parameters of the device although both configurations tested yielded temperature increases sufficient for ablation. Resected livers from live ablations exhibited clear thermal lesions. MR-RFA holds potential for integrating RF ablation tumor therapy with MRI scanning. MR-RFA may add value to MRI with the addition of a potentially disposable ablation device, while retaining MRI's ability to provide real time procedure guidance and measurement of tissue temperature, perfusion, and coagulation.
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Aarntzen EH, Heijmen L, Oyen WJ. 18F-FDG PET/CT in Local Ablative Therapies: A Systematic Review. J Nucl Med 2018; 59:551-556. [DOI: 10.2967/jnumed.117.198184] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2017] [Accepted: 12/13/2017] [Indexed: 12/13/2022] Open
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Cohen EI, Field D, Lynskey GE, Kim AY. Technology of irreversible electroporation and review of its clinical data on liver cancers. Expert Rev Med Devices 2018; 15:99-106. [PMID: 29307242 DOI: 10.1080/17434440.2018.1425612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Irreversible electroporation (IRE) has developed as a novel percutaneous ablative technique over the past decade and its utility in the treatment of primary and metastatic liver disease has progressed rapidly. AREAS COVERED After discussing the principles behind the technology and the practical steps in its use, this article offers a detailed analysis of the recent published work that evaluates its safety and efficacy. The strengths and weaknesses of other ablative techniques, including radiofrequency ablation, microwave ablation and cryoablation, are discussed in detail. Other aspects of IRE, including post-treatment clinical follow-up, expected imaging findings, and the most frequently encountered complications, are covered. Finally, the future of IRE is examined as it pertains to advancements in the treatment of hepatic malignancy. EXPERT COMMENTARY The characteristics of IRE that make this technology uniquely suited for the treatment of liver tumors have allowed it to gain a significant foothold in interventional oncology. Continued development of IRE will lead to further advances in the management of previously untreatable liver cancers.
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Affiliation(s)
- Emil I Cohen
- a Division of Interventional Radiology, Department of Radiology , Medstar Georgetown University Hospital , Washington , DC , USA
| | - David Field
- a Division of Interventional Radiology, Department of Radiology , Medstar Georgetown University Hospital , Washington , DC , USA
| | - George Emmett Lynskey
- a Division of Interventional Radiology, Department of Radiology , Medstar Georgetown University Hospital , Washington , DC , USA
| | - Alexander Y Kim
- a Division of Interventional Radiology, Department of Radiology , Medstar Georgetown University Hospital , Washington , DC , USA
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Yoshimatsu R, Doi A, Yamanishi T, Nishimori M, Ogi K, Kajiwara K, Tamura T, Minamiguchi H, Yamagami T. Prediction of the ablated area prior to radiofrequency ablation for liver tumor under CT guidance. MINIM INVASIV THER 2017; 27:22-26. [DOI: 10.1080/13645706.2017.1407799] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Rika Yoshimatsu
- Department of Radiology, Kochi University, Kochi Medical School, Nankoku, Japan
| | - Akinori Doi
- Clinical Radiology Department, Kochi Medical School Hospital, Nankoku, Japan
| | - Tomoaki Yamanishi
- Department of Radiology, Kochi University, Kochi Medical School, Nankoku, Japan
| | - Miki Nishimori
- Department of Radiology, Kochi University, Kochi Medical School, Nankoku, Japan
| | - Kenta Ogi
- Department of Radiology, Kochi University, Kochi Medical School, Nankoku, Japan
| | - Kenji Kajiwara
- Department of Radiology, Kochi University, Kochi Medical School, Nankoku, Japan
| | - Taiji Tamura
- Department of Radiology, Kochi University, Kochi Medical School, Nankoku, Japan
- Department of Radiology, Aki Municipal Hospital, Aki, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Kochi University, Kochi Medical School, Nankoku, Japan
| | - Takuji Yamagami
- Department of Radiology, Kochi University, Kochi Medical School, Nankoku, Japan
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Garnon J, Tricard T, Cazzato RL, Cathelineau X, Gangi A, Lang H. [Percutaneous renal ablation: Pre-, per-, post-interventional evaluation modalities and adapted management]. Prog Urol 2017; 27:971-993. [PMID: 28942001 DOI: 10.1016/j.purol.2017.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/20/2017] [Accepted: 08/23/2017] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Ablative treatment (AT) rise is foreseen, validation of steps to insure good proceedings is needed. By looking over the process of the patient, this study evaluates the requirements and choices needed in every step of the management. METHODS We searched MEDLINE®, Embase®, using (MeSH) words and we looked for all the studies. Investigators graded the strength of evidence in terms of methodology, language and relevance. RESULTS Explanations of AT proposal rather than partial nephrectomy or surveillance have to be discussed in a consultation shared by urologist and interventional radiologist. Per-procedure choices depend on predictable ballistic difficulties. High volume, proximity of the hilum or of a risky organ are in favor of general anesthesia, cryotherapy and computed tomography/magnetic resonance imaging (CT/MRI). Percutaneous approach should be privileged, as it seems as effective as the laparoscopic approach. Early and delayed complications have to be treated both by urologist and radiologist. Surveillance by CT/MRI insure of the lack of contrast-enhanced in the treated area. Patients and tumors criteria, in case of incomplete treatment or recurrence, are the key of the appropriate treatment: surgery, second session of AT, surveillance. CONCLUSION AT treatments require patient's comprehension, excellent coordination of the partnership between urologist and radiologist and relevant choices during intervention.
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Affiliation(s)
- J Garnon
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - T Tricard
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France.
| | - R L Cazzato
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - X Cathelineau
- Département d'urologie, institut Montsouris, 75014 Paris, France; Université Paris-Descartes, 75006 Paris, France
| | - A Gangi
- Service d'imagerie interventionnelle, CHU de Strasbourg, 67000 Strasbourg, France
| | - H Lang
- Service de chirurgie urologique, CHU de Strasbourg, 67000 Strasbourg, France
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Abstract
BACKGROUND Imaging plays an important role not only in screening, evaluating, staging, and monitoring disease, but also in surveillance following tumor ablation. Advances in imaging techniques have increased our ability to detect and characterize focal liver lesions, resulting in improvements in diagnostic capability and improved monitoring of liver metastases. This has led to increased interest in both hepatic imaging and image-guided hepatic interventions. METHODS Several imaging options are reviewed according to their effective application, notably computed tomography (CT), CT during arterial portography, ultrasound, magnetic resonance imaging, positron emission tomography, and integrated PET/CT imaging. RESULTS Although there are exceptions regarding imaging options based on patient selection and on institution preference and expertise, multidetector helical CT scanning remains the dominant modality in the evaluation of suspected hepatic metastases, and for preoperative planning, treatment monitoring, and posttreatment follow-up. CONCLUSIONS Ultimately, the choice of imaging modality must be based not only on the patient and the clinical situation, but also on the imaging expertise within each institution.
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Affiliation(s)
- Junsung Choi
- Department of Radiology, H. Lee Moffitt Cancer Center & Research Institute, Tampa, FL 33612, USA.
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Liver-Directed Therapy for Hepatocellular Carcinoma: An Overview of Techniques, Outcomes, and Posttreatment Imaging Findings. AJR Am J Roentgenol 2017; 209:67-76. [DOI: 10.2214/ajr.17.17799] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Mader A, Mader OM, Gröner D, Korkusuz Y, Ahmad S, Grünwald F, Kranert WT, Happel C. Minimally invasive local ablative therapies in combination with radioiodine therapy in benign thyroid disease: preparation, feasibility and efficiency - preliminary results. Int J Hyperthermia 2017; 33:895-904. [PMID: 28540810 DOI: 10.1080/02656736.2017.1320813] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Initial studies of combinations of radioiodine therapy (RIT) and local ablative procedures for the treatment of thyroid nodules have shown promising results. The goal of this study was to evaluate the effectiveness of RIT combined with radiofrequency ablation (RFA) in patients with goitres and to determine which ablative procedure is the most suitable for a combined therapy. METHODS Thirty patients with goitres were divided into two subgroups. A test group of 15 patients received combined therapy (RIT + RFA) and a control group of 15 patients received RIT mono therapy. All patients underwent assessments including ultrasound, laboratory evaluation (T3, T4, TSH, TG, TPOAb, TgAbTRAb) and scintigraphic imaging with Tc-99m-Pertechnetate. The 3-month volume reduction was used to evaluate therapy effectiveness. RESULTS Combined therapy (subgroup 1) resulted in a significant (p < 0.05) thyroid volume reduction (22.3 ± 54 ml/32.2 ± 58.2%) with better performance (p > 0.05) than the control group (20.2 ± 32.2 ml/29.6 ± 42.1%). All patients became euthyroid after treatment. No major discomfort or complications occurred. A review of the literature investigating combinations of other local ablative procedures with RIT was performed to determine the most promising combination. CONCLUSIONS The present study confirms the positive experiences with the combined therapy of RIT and local ablative procedures shown in the current literature and approves this approach for the treatment of goitres with RFA + RIT. These findings, when confirmed by further studies, should expand the indication of combined therapy as a minimally invasive alternative to surgery.
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Affiliation(s)
- Alexander Mader
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Oscar Maximilian Mader
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Daniel Gröner
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Yücel Korkusuz
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Shadi Ahmad
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Frank Grünwald
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - W Tilman Kranert
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
| | - Christian Happel
- a Department of Nuclear Medicine , University Hospital Frankfurt am Main , Frankfurt am Main , Germany
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Feng C, Hu B, Hu B, Chen L, Li J, Huang J. Comparative study of conventional US, contrast enhanced US and enhanced MR for the follow-up of prostatic radiofrequency ablation. Exp Ther Med 2017; 13:3535-3542. [PMID: 28588677 DOI: 10.3892/etm.2017.4399] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 01/06/2017] [Indexed: 12/23/2022] Open
Abstract
The aim of the present study was to evaluate and compare the effectiveness of different imaging methods during follow-up of prostatic radiofrequency ablation. Prostatic radiofrequency ablation (RFA) was performed in 20 healthy beagle dogs. Various imaging examinations were used to monitor the results of RFA, including conventional ultrasound (US), contrast enhanced ultrasound (CEUS) and enhanced magnetic resonance (MR). Imaging exams were performed at five phases: Immediately following RFA, one week later, one month later, three months later and six months later. The morphology for each imaging test and histological results were recorded and compared in each phase. Based on the actual results from autopsy, the accuracy of those imaging exams was evaluated. The canine prostate gland demonstrated typical coagulative necrosis immediately following RFA. The lesion would develop into stable cyst if no other complications occurred within the six-month follow-up. Regarding the RFA lesion volume measurement and the reflection of pathological changes, conventional US was not able to accurately measure the volume of RFA lesion and missed many more details concerning the RFA-treated area than CEUS and MR during the three months. The results from CEUS exhibited comparable accuracy to those from enhanced MR at each phase. However, there were no significant differences in the results from US, CEUS and MR at six months, which may contribute to the complete formation of lesion cyst. In the early phase, conventional US was not sufficient for evaluating the efficacy of RFA. Enhanced US and MR provided clear images and accurate information. However, CEUS has the advantage of being more economical, using more convenient equipment and faster scanning, thus identifying it as the more feasible choice. Furthermore, no notable advantages were observed among any image examinations in the long-term follow-up.
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Affiliation(s)
- Chao Feng
- Department of Urology, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Bin Hu
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Bing Hu
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Lei Chen
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Jia Li
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
| | - Jin Huang
- Department of Pathology, Shanghai Institute of Ultrasound in Medicine, Shanghai Jiaotong University Affiliated Sixth People's Hospital, Shanghai 200233, P.R. China
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Moon S, Park S, Lee SK, Cheon B, Hong S, Cho H, Park JG, Alfajaro MM, Cho KO, Woo D, Choi J. Comparison of elastography, contrast-enhanced ultrasonography, and computed tomography for assessment of lesion margin after radiofrequency ablation in livers of healthy dogs. Am J Vet Res 2017; 78:295-304. [DOI: 10.2460/ajvr.78.3.295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Abstract
OBJECTIVE To assess by use of various diagnostic imaging modalities acute changes in livers of healthy dogs after radiofrequency ablation (RFA) and determine the capability of each imaging modality to monitor ablation lesion changes.
ANIMALS 6 healthy Beagles.
PROCEDURES 12 ablation lesions were created in the liver of the dogs (2 lesions/dog). Ablation lesions were evaluated by use of conventional ultrasonography, strain elastography, and contrast-enhanced ultrasonography immediately after (time 0), 30 to 60 minutes after, and 3 days after RFA, and by use of CT 30 minutes and 3 days after RFA. Three dogs were euthanized shortly after RFA, and the other 3 dogs were euthanized on day 3. Lesion size measured by each imaging modality was compared with necropsy findings.
RESULTS Immediately after RFA, clear margins were more visible with elastography and contrast-enhanced ultrasonography than with conventional ultrasonography, which had acoustic shadowing. On triphasic contrast CT, the ablation zone, which indicated necrosis and hemorrhage, was not enhanced and could be measured. Marked enhancement of the periablation rim was observed during the venous phase and was identified as granulation tissue. Size of the ablation area measured on enhanced CT images was strongly correlated with actual lesion size.
CONCLUSIONS AND CLINICAL RELEVANCE For dogs of this study, CT was the most reliable method for lesion size determination. Although ultrasonographic imaging measurements underestimated lesion size, all modalities could be used to provide additional real-time guidance for RFA procedures of the liver as well as for other RFA procedures.
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Zurbuchen U, Poch F, Gemeinhardt O, Kreis ME, Niehues SM, Vahldieck JL, Lehmann KS. Determination of the electrical conductivity of human liver metastases: impact on therapy planning in the radiofrequency ablation of liver tumors. Acta Radiol 2017; 58:164-169. [PMID: 27055920 DOI: 10.1177/0284185116639765] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Radiofrequency ablation is used to induce thermal necrosis in the treatment of liver metastases. The specific electrical conductivity of a liver metastasis has a distinct influence on the heat formation and resulting tumor ablation within the tissue. Purpose To examine the electrical conductivity σ of human colorectal liver metastases and of tumor-free liver tissue in surgical specimens. Material and Methods Surgical specimens from patients with resectable colorectal liver metastases were used for measurements (size of metastases <30 mm). A four-needle measuring probe was used to determine the electrical conductivity σ of human colorectal liver metastasis (n = 8) and tumor-free liver tissue (n = 5) in a total of five patients. All measurements were performed at 470 kHz, which is the relevant frequency for radiofrequency ablation. The tissue temperature was also measured. Hepatic resections were performed in accordance with common surgical standards. Measurements were performed in the operating theater immediately after resection. Results The median electrical conductivity σ was 0.57 S/m in human colorectal liver metastases at a median temperature of 35.1℃ and 0.35 S/m in tumor-free liver tissue at a median temperature of 34.9℃. The electrical conductivity was significantly higher in tumor tissue than in tumor-free liver tissue ( P = 0.005). There were no differences in tissue temperature between the two groups ( P = 0.883). Conclusion The electrical conductivity is significantly higher in human colorectal liver metastases than in tumor-free liver tissue at a frequency of 470 kHz.
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Affiliation(s)
| | - Franz Poch
- Charité–Universitätsmedizin Berlin, Berlin, Germany
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Pregler B, Beyer L, Wiesinger I, Nießen C, Jung E, Stroszczynski C, Wiggermann P. Microwave ablation of large HCC lesions: Added value of CEUS examinations for ablation success control. Clin Hemorheol Microcirc 2017; 64:483-490. [DOI: 10.3233/ch-168113] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Comprehensive preclinical evaluation of a multi-physics model of liver tumor radiofrequency ablation. Int J Comput Assist Radiol Surg 2017; 12:1543-1559. [DOI: 10.1007/s11548-016-1517-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 12/21/2016] [Indexed: 10/20/2022]
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Fan QY, Zhou Y, Zhang M, Ma B, Yang T, Long H, Yu Z, Li Z. Microwave ablation of malignant extremity bone tumors. SPRINGERPLUS 2016; 5:1373. [PMID: 27606161 PMCID: PMC4992478 DOI: 10.1186/s40064-016-3005-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 08/05/2016] [Indexed: 11/10/2022]
Abstract
Background The current application of limb salvage process has some unsolved problems, such as prosthesis loosening, which severely limits the function of the preserved limbs. Innovative approaches are needed to further improve functional outcome. Patients and methods Instead of en-bloc resection of tumor-bearing bone, it is dissected from the surrounding normal tissues, followed by devitalizing the bone segment and the extra-cortical bulk by microwave induced hyperthermia in situ through the antenna array. From May 1999 to March 2012, 544 patients with malignant bone tumors of the extremities were treated by the novel method. Results The over 3-year survival rate was 59.1 % for high-grade malignancy, 88.7 % for low-grade malignancy. In the majority of the patients, cosmetic and useful limbs were preserved. Local recurrence rate was 9.8 % for the high grade malignancy (mainly occurred at the early stage of the research). The overall fracture rate was 2.6 %. Deep infection rate was 1.8 %. The complication rate is lower than the literature reports. After heat necrosis, the dead bone maintains both the osteoconduction and osteoinduction properties. Conclusions The application of microwave induced hyperthermia for treatment of malignant bone tumors, except the late diagnosed cases who’s tumor-bearing bone was destroyed too severe to do biological reconstruction, is an effective, simple, and inexpensive method. The oncological and functional results are encouraging.
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Affiliation(s)
- Qing-Yu Fan
- Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an, Shaanxi China
| | - Yong Zhou
- Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an, Shaanxi China
| | - Minghua Zhang
- Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an, Shaanxi China
| | - Baoan Ma
- Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an, Shaanxi China
| | - Tongtao Yang
- Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an, Shaanxi China
| | - Hua Long
- Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an, Shaanxi China
| | - Zhe Yu
- Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an, Shaanxi China
| | - Zhao Li
- Tangdu Hospital, Fourth Military Medical University, 569 Xinsi Road, Baqiao District, Xi'an, Shaanxi China
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Bouda D, Lagadec M, Alba CG, Barrau V, Dioguardi Burgio M, Moussa N, Vilgrain V, Ronot M. Imaging review of hepatocellular carcinoma after thermal ablation: The good, the bad, and the ugly. J Magn Reson Imaging 2016; 44:1070-1090. [DOI: 10.1002/jmri.25369] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Accepted: 06/16/2016] [Indexed: 12/11/2022] Open
Affiliation(s)
- Damien Bouda
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Matthieu Lagadec
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Carmela Garcia Alba
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Vincent Barrau
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Marco Dioguardi Burgio
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Nadia Moussa
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
| | - Valérie Vilgrain
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
- University Paris Diderot; Sorbonne Paris Cité, INSERM UMR 1149 Paris France
| | - Maxime Ronot
- Radiology Department; Beaujon Hospital, University Hospitals Paris Nord Val de Seine, Assistance Publique-Hôpitaux de Paris, APHP; Clichy France
- University Paris Diderot; Sorbonne Paris Cité, INSERM UMR 1149 Paris France
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Affiliation(s)
- Lawrence Lau
- Department of Mechanical Engineering, Seattle University, Seattle, WA 98122
| | - Yen-Lin Han
- Department of Mechanical Engineering, Seattle University, Seattle, WA 98122
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Wandel A, Ben-David E, Ulusoy BS, Neal R, Faruja M, Nissenbaum I, Gourovich S, Goldberg SN. Optimizing Irreversible Electroporation Ablation with a Bipolar Electrode. J Vasc Interv Radiol 2016; 27:1441-1450.e2. [PMID: 27475242 DOI: 10.1016/j.jvir.2016.06.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 06/01/2016] [Accepted: 06/01/2016] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To optimize single-insertion bipolar irreversible electroporation (IRE) by characterizing effects of electric parameters and controlling tissue electric properties in a porcine model. MATERIALS AND METHODS Single-insertion electrode bipolar IRE was performed in 28 in vivo pig livers (78 ablations). First, effects of voltage (2,700-3,000 V), number of pulses, repeated cycles (1-6 cycles), and pulse width (70-100 µs) were studied. Next, electric conductivity was altered by instillation of hypertonic and hypotonic fluids. Finally, effects of thermal stabilization were assessed using internal electrode cooling. Treatment effect was evaluated 2-3 hours after IRE. Dimensions were compared and subjected to statistical analysis. RESULTS Delivering 3,000 V at 70 µs for a single 90-pulse cycle yielded 3.8 cm ± 0.4 × 2.0 cm ± 0.3 of ablation. Applying 6 cycles of energy increased ablation to 4.5 cm ± 0.4 × 2.6 cm ± 0.3 (P < .001). Further increasing pulse lengths to 100 µs (6 cycles) increased ablation to 5.0 cm ± 0.4 × 2.9 cm ± 0.3 (P < .001) but resulted in electric spikes and system crashes in 40%-50% of cases. Increasing tissue electric conductivity via hypertonic solution instillation in surrounding tissues increased frequency of generator crashes, whereas continuous instillation of distilled water eliminated this arcing phenomenon but reduced ablation to 2.3 cm ± 0.1. Controlled instillation of distilled water when electric arcing was suspected from audible popping produced ablations of 5.3 cm ± 0.6 × 3.1 cm ±0.3 without crashes. Finally, 3.1 cm ± 0.1 short-axis ablation was achieved without system crashes with internal electrode perfusion at 37°C versus 2.3 cm ± 0.1 with 4°C-10°C perfusion (P < .001). CONCLUSIONS Bipolar IRE ablation zones can be increased with repetitive high voltage and greater pulse widths accompanied by either judicious instillation of hypotonic fluids or internal electrode perfusion to minimize unwanted electric arcing.
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Affiliation(s)
- Ayelet Wandel
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, POB 12000, Ein Kerem, Jerusalem 9112001, Israel; Department of Diagnostic Imaging, Wolfson Medical Center, affiliated with the Sackler Faculty of Medicine, Tel-Aviv University, Holon, Israel
| | - Eliel Ben-David
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, POB 12000, Ein Kerem, Jerusalem 9112001, Israel.
| | - B Said Ulusoy
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, POB 12000, Ein Kerem, Jerusalem 9112001, Israel
| | | | - Mohammad Faruja
- Department of Surgery, Hadassah Hebrew University Medical Center, POB 12000, Ein Kerem, Jerusalem 9112001, Israel
| | - Isaac Nissenbaum
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, POB 12000, Ein Kerem, Jerusalem 9112001, Israel
| | - Svetlana Gourovich
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, POB 12000, Ein Kerem, Jerusalem 9112001, Israel
| | - S Nahum Goldberg
- Department of Diagnostic Imaging, Hadassah Hebrew University Medical Center, POB 12000, Ein Kerem, Jerusalem 9112001, Israel
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