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Ultrasound-Guided Percutaneous Radiofrequency Ablation of Liver Tumors: How We Do It Safely and Completely

  • Kim, Jin Woong (Department of Radiology, Chonnam National University Medical School) ;
  • Shin, Sang Soo (Department of Radiology, Chonnam National University Medical School) ;
  • Heo, Suk Hee (Department of Radiology, Chonnam National University Medical School) ;
  • Hong, Jun Hyung (Department of Radiology, Chonnam National University Medical School) ;
  • Lim, Hyo Soon (Department of Radiology, Chonnam National University Medical School) ;
  • Seon, Hyun Ju (Department of Radiology, Chonnam National University Medical School) ;
  • Hur, Young Hoe (Department of Hepato-Pancreato-Biliary Surgery, Chonnam National University Medical School) ;
  • Park, Chang Hwan (Department of Internal Medicine, Chonnam National University Medical School) ;
  • Jeong, Yong Yeon (Department of Radiology, Chonnam National University Medical School) ;
  • Kang, Heoung Keun (Department of Radiology, Chonnam National University Medical School)
  • Received : 2015.03.27
  • Accepted : 2015.07.04
  • Published : 2015.11.01

Abstract

Ultrasound-guided percutaneous radiofrequency (RF) ablation has become one of the most promising local cancer therapies for both resectable and nonresectable hepatic tumors. Although RF ablation is a safe and effective technique for the treatment of liver tumors, the outcome of treatment can be closely related to the location and shape of the tumors. There may be difficulties with RF ablation of tumors that are adjacent to large vessels or extrahepatic heat-vulnerable organs and tumors in the caudate lobe, possibly resulting in major complications or treatment failure. Thus, a number of strategies have been developed to overcome these challenges, which include artificial ascites, needle track ablation, fusion imaging guidance, parallel targeting, bypass targeting, etc. Operators need to use the right strategy in the right situation to avoid the possibility of complications and incomplete thermal tissue destruction; with the right strategy, RF ablation can be performed successfully, even for hepatic tumors in high-risk locations. This article offers technical strategies that can be used to effectively perform RF ablation as well as to minimize possible complications related to the procedure with representative cases and schematic illustrations.

Keywords

References

  1. Kim YS, Lim HK, Rhim H, Lee MW, Choi D, Lee WJ, et al. Tenyear outcomes of percutaneous radiofrequency ablation as first-line therapy of early hepatocellular carcinoma: analysis of prognostic factors. J Hepatol 2013;58:89-97 https://doi.org/10.1016/j.jhep.2012.09.020
  2. Shiina S, Tateishi R, Arano T, Uchino K, Enooku K, Nakagawa H, et al. Radiofrequency ablation for hepatocellular carcinoma: 10-year outcome and prognostic factors. Am J Gastroenterol 2012;107:569-577; quiz 578 https://doi.org/10.1038/ajg.2011.425
  3. Giannini EG, Farinati F, Del Poggio P, Rapaccini GL, Di Nolfo MA, Benvegnù L, et al. Ten-year outcome of radiofrequency thermal ablation for hepatocellular carcinoma: an Italian experience. Am J Gastroenterol 2012;107:1588-1589; author reply 1590
  4. Forner A, Llovet JM, Bruix J. Hepatocellular carcinoma. Lancet 2012;379:1245-1255 https://doi.org/10.1016/S0140-6736(11)61347-0
  5. Livraghi T, Meloni F, Di Stasi M, Rolle E, Solbiati L, Tinelli C, et al. Sustained complete response and complications rates after radiofrequency ablation of very early hepatocellular carcinoma in cirrhosis: is resection still the treatment of choice? Hepatology 2008;47:82-89
  6. Thanos L, Mylona S, Galani P, Pomoni M, Pomoni A, Koskinas I. Overcoming the heat-sink phenomenon: successful radiofrequency thermal ablation of liver tumors in contact with blood vessels. Diagn Interv Radiol 2008;14:51-56
  7. Rhim H, Yoon KH, Lee JM, Cho Y, Cho JS, Kim SH, et al. Major complications after radio-frequency thermal ablation of hepatic tumors: spectrum of imaging findings. Radiographics 2003;23:123-134; discussion 134-136 https://doi.org/10.1148/rg.231025054
  8. Livraghi T, Solbiati L, Meloni MF, Gazelle GS, Halpern EF, Goldberg SN. Treatment of focal liver tumors with percutaneous radio-frequency ablation: complications encountered in a multicenter study. Radiology 2003;226:441-451 https://doi.org/10.1148/radiol.2262012198
  9. Mendiratta-Lala M, Brook OR, Midkiff BD, Brennan DD, Thornton E, Faintuch S, et al. Quality initiatives: strategies for anticipating and reducing complications and treatment failures in hepatic radiofrequency ablation. Radiographics 2010;30:1107-1122 https://doi.org/10.1148/rg.304095202
  10. Shibata T, Isoda H, Hirokawa Y, Arizono S, Shimada K, Togashi K. Small hepatocellular carcinoma: is radiofrequency ablation combined with transcatheter arterial chemoembolization more effective than radiofrequency ablation alone for treatment? Radiology 2009;252:905-913 https://doi.org/10.1148/radiol.2523081676
  11. Kitamoto M, Nakanishi T, Kira S, Kawaguchi M, Nakashio R, Suemori S, et al. The assessment of proliferating cell nuclear antigen immunohistochemical staining in small hepatocellular carcinoma and its relationship to histologic characteristics and prognosis. Cancer 1993;72:1859-1865 https://doi.org/10.1002/1097-0142(19930915)72:6<1859::AID-CNCR2820720612>3.0.CO;2-A
  12. Kim JW, Shin SS, Kim JK, Choi SK, Heo SH, Lim HS, et al. Radiofrequency ablation combined with transcatheter arterial chemoembolization for the treatment of single hepatocellular carcinoma of 2 to 5 cm in diameter: comparison with surgical resection. Korean J Radiol 2013;14:626-635 https://doi.org/10.3348/kjr.2013.14.4.626
  13. Goldberg SN, Bonn J, Dodd G, Dupuy D, Geschwind JH, Hicks M, et al. Society of Interventional Radiology Interventional Oncology Task Force: interventional oncology research vision statement and critical assessment of the state of research affairs. J Vasc Interv Radiol 2005;16:1287-1294 https://doi.org/10.1097/01.RVI.0000182220.11020.55
  14. Kim YS, Lee WJ, Rhim H, Lim HK, Choi D, Lee JY. The minimal ablative margin of radiofrequency ablation of hepatocellular carcinoma (> 2 and < 5 cm) needed to prevent local tumor progression: 3D quantitative assessment using CT image fusion. AJR Am J Roentgenol 2010;195:758-765 https://doi.org/10.2214/AJR.09.2954
  15. Nakazawa T, Kokubu S, Shibuya A, Ono K, Watanabe M, Hidaka H, et al. Radiofrequency ablation of hepatocellular carcinoma: correlation between local tumor progression after ablation and ablative margin. AJR Am J Roentgenol 2007;188:480-488 https://doi.org/10.2214/AJR.05.2079
  16. Song I, Rhim H, Lim HK, Kim YS, Choi D. Percutaneous radiofrequency ablation of hepatocellular carcinoma abutting the diaphragm and gastrointestinal tracts with the use of artificial ascites: safety and technical efficacy in 143 patients. Eur Radiol 2009;19:2630-2640 https://doi.org/10.1007/s00330-009-1463-x
  17. Rhim H, Lim HK, Kim YS, Choi D. Percutaneous radiofrequency ablation with artificial ascites for hepatocellular carcinoma in the hepatic dome: initial experience. AJR Am J Roentgenol 2008;190:91-98 https://doi.org/10.2214/AJR.07.2384
  18. Kang TW, Lee MW, Hye MJ, Song KD, Lim S, Rhim H, et al. Percutaneous radiofrequency ablation of hepatic tumours: factors affecting technical failure of artificial ascites formation using an angiosheath. Clin Radiol 2014;69:1249-1258 https://doi.org/10.1016/j.crad.2014.07.012
  19. Koda M, Ueki M, Maeda Y, Mimura K, Okamoto K, Matsunaga Y, et al. Percutaneous sonographically guided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma located under the diaphragm. AJR Am J Roentgenol 2004;183:583-588 https://doi.org/10.2214/ajr.183.3.1830583
  20. Minami Y, Kudo M, Kawasaki T, Chung H, Ogawa C, Inoue T, et al. Percutaneous ultrasound-guided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma in the hepatic dome. J Gastroenterol 2003;38:1066-1070 https://doi.org/10.1007/s00535-003-1197-5
  21. Kim YJ, Lee MW, Park HS. Small hepatocellular carcinomas: ultrasonography guided percutaneous radiofrequency ablation. Abdom Imaging 2013;38:98-111 https://doi.org/10.1007/s00261-012-9883-5
  22. Teratani T, Yoshida H, Shiina S, Obi S, Sato S, Tateishi R, et al. Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations. Hepatology 2006;43:1101-1108 https://doi.org/10.1002/hep.21164
  23. Kwon HJ, Kim PN, Byun JH, Kim KW, Won HJ, Shin YM, et al. Various complications of percutaneous radiofrequency ablation for hepatic tumors: radiologic findings and technical tips. Acta Radiol 2014;55:1082-1092 https://doi.org/10.1177/0284185113513893
  24. Akahane M, Koga H, Kato N, Yamada H, Uozumi K, Tateishi R, et al. Complications of percutaneous radiofrequency ablation for hepato-cellular carcinoma: imaging spectrum and management. Radiographics 2005;25 Suppl 1:S57-S68 https://doi.org/10.1148/rg.25si055505
  25. McGhana JP, Dodd GD 3rd. Radiofrequency ablation of the liver: current status. AJR Am J Roentgenol 2001;176:3-16 https://doi.org/10.2214/ajr.176.1.1760003
  26. Liu N, Gao J, Liu Y, Li T, Feng K, Ma K, et al. Determining a minimal safe distance to prevent thermal injury to intrahepatic bile ducts in radiofrequency ablation of the liver: a study in dogs. Int J Hyperthermia 2012;28:210-217 https://doi.org/10.3109/02656736.2012.661915
  27. Ogawa T, Kawamoto H, Kobayashi Y, Nakamura S, Miyatake H, Harada R, et al. Prevention of biliary complication in radiofrequency ablation for hepatocellular carcinoma-Cooling effect by endoscopic nasobiliary drainage tube. Eur J Radiol 2010;73:385-390 https://doi.org/10.1016/j.ejrad.2008.10.021
  28. Kong WT, Zhang WW, Qiu YD, Zhou T, Qiu JL, Zhang W, et al. Major complications after radiofrequency ablation for liver tumors: analysis of 255 patients. World J Gastroenterol 2009;15:2651-2156 https://doi.org/10.3748/wjg.15.2651
  29. Jaskolka JD, Asch MR, Kachura JR, Ho CS, Ossip M, Wong F, et al. Needle tract seeding after radiofrequency ablation of hepatic tumors. J Vasc Interv Radiol 2005;16:485-491 https://doi.org/10.1097/01.RVI.0000151141.09597.5F
  30. Livraghi T, Lazzaroni S, Meloni F, Solbiati L. Risk of tumour seeding after percutaneous radiofrequency ablation for hepatocellular carcinoma. Br J Surg 2005;92:856-858 https://doi.org/10.1002/bjs.4986
  31. Llovet JM, Vilana R, Brú C, Bianchi L, Salmeron JM, Boix L, et al. Increased risk of tumor seeding after percutaneous radiofrequency ablation for single hepatocellular carcinoma. Hepatology 2001;33:1124-1129 https://doi.org/10.1053/jhep.2001.24233
  32. Rhim H, Goldberg SN, Dodd GD 3rd, Solbiati L, Lim HK, Tonolini M, et al. Essential techniques for successful radiofrequency thermal ablation of malignant hepatic tumors. Radiographics 2001;21 Spec No:S17-S35; discussion S36-S39 https://doi.org/10.1148/radiographics.21.suppl_1.g01oc11s17
  33. Seror O, Haddar D, N’Kontchou G, Ajavon Y, Trinchet JC, Beaugrand M, et al. Radiofrequency ablation for the treatment of liver tumors in the caudate lobe. J Vasc Interv Radiol 2005;16:981-990 https://doi.org/10.1097/01.RVI.0000159859.71448.8A
  34. Lu DS, Raman SS, Limanond P, Aziz D, Economou J, Busuttil R, et al. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol 2003;14:1267-1274 https://doi.org/10.1097/01.RVI.0000092666.72261.6B
  35. Cha DI, Lee MW, Rhim H, Choi D, Kim YS, Lim HK. Therapeutic efficacy and safety of percutaneous ethanol injection with or without combined radiofrequency ablation for hepatocellular carcinomas in high risk locations. Korean J Radiol 2013;14:240-247 https://doi.org/10.3348/kjr.2013.14.2.240
  36. Lee MW, Rhim H, Cha DI, Kim YJ, Choi D, Kim YS, et al. Percutaneous radiofrequency ablation of hepatocellular carcinoma: fusion imaging guidance for management of lesions with poor conspicuity at conventional sonography. AJR Am J Roentgenol 2012;198:1438-1444 https://doi.org/10.2214/AJR.11.7568
  37. Kunishi Y, Numata K, Morimoto M, Okada M, Kaneko T, Maeda S, et al. Efficacy of fusion imaging combining sonography and hepatobiliary phase MRI with Gd-EOB-DTPA to detect small hepatocellular carcinoma. AJR Am J Roentgenol 2012;198:106-114 https://doi.org/10.2214/AJR.10.6039
  38. Rajesh S, Mukund A, Arora A, Jain D, Sarin SK. Contrastenhanced US-guided radiofrequency ablation of hepatocellular carcinoma. J Vasc Interv Radiol 2013;24:1235-1240 https://doi.org/10.1016/j.jvir.2013.04.013
  39. Kim AY, Lee MW, Rhim H, Cha DI, Choi D, Kim YS, et al. Pretreatment evaluation with contrast-enhanced ultrasonography for percutaneous radiofrequency ablation of hepatocellular carcinomas with poor conspicuity on conventional ultrasonography. Korean J Radiol 2013;14:754-763 https://doi.org/10.3348/kjr.2013.14.5.754
  40. Lu DS, Yu NC, Raman SS, Limanond P, Lassman C, Murray K, et al. Radiofrequency ablation of hepatocellular carcinoma: treatment success as defined by histologic examination of the explanted liver. Radiology 2005;234:954-960 https://doi.org/10.1148/radiol.2343040153
  41. Kang TW, Lim HK, Lee MW, Kim YS, Choi D, Rhim H. Perivascular versus nonperivascular small HCC treated with percutaneous RF ablation: retrospective comparison of longterm therapeutic outcomes. Radiology 2014;270:888-899 https://doi.org/10.1148/radiol.13130753
  42. Kim JH, Won HJ, Shin YM, Kim SH, Yoon HK, Sung KB, et al. Medium-sized (3.1-5.0 cm) hepatocellular carcinoma: transarterial chemoembolization plus radiofrequency ablation versus radiofrequency ablation alone. Ann Surg Oncol 2011;18:1624-1629 https://doi.org/10.1245/s10434-011-1673-8
  43. Yoon JH, Lee JM, Hwang EJ, Hwang IP, Baek J, Han JK, et al. Monopolar radiofrequency ablation using a dual-switching system and a separable clustered electrode: evaluation of the in vivo efficiency. Korean J Radiol 2014;15:235-244 https://doi.org/10.3348/kjr.2014.15.2.235
  44. Yoon JH, Lee JM, Han JK, Choi BI. Dual switching monopolar radiofrequency ablation using a separable clustered electrode: comparison with consecutive and switching monopolar modes in ex vivo bovine livers. Korean J Radiol 2013;14:403-411 https://doi.org/10.3348/kjr.2013.14.3.403
  45. Lee ES, Lee JM, Kim KW, Lee IJ, Han JK, Choi BI. Evaluation of the in vivo efficiency and safety of hepatic radiofrequency ablation using a 15-G $Octopus^{(R)}$ in pig liver. Korean J Radiol 2013;14:194-201 https://doi.org/10.3348/kjr.2013.14.2.194
  46. Woo S, Lee JM, Yoon JH, Joo I, Kim SH, Lee JY, et al. Smalland medium-sized hepatocellular carcinomas: monopolar radiofrequency ablation with a multiple-electrode switching system-mid-term results. Radiology 2013;268:589-600 https://doi.org/10.1148/radiol.13121736

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