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New Radiofrequency Device to Reduce Bleeding after Core Needle Biopsy: Experimental Study in a Porcine Liver Model

  • Lim, Sanghyeok (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Rhim, Hyunchul (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Min Woo (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Song, Kyoung Doo (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kang, Tae Wook (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Young-sun (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lim, Hyo Keun (Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2016.05.11
  • Accepted : 2016.08.20
  • Published : 2017.01.01

Abstract

Objective: To evaluate the in vivo efficiency of the biopsy tract radiofrequency ablation for hemostasis after core biopsy of the liver in a porcine liver model, including situations with bleeding tendency and a larger (16-gauge) core needle. Materials and Methods: A preliminary study was performed using one pig to determine optimal ablation parameters. For the main experiment, four pigs were assigned to different groups according to heparinization use and biopsy needle caliber. In each pig, 14 control (without tract ablation) and 14 experimental (tract ablation) ultrasound-guided core biopsies were performed using either an 18- or 16-gauge needle. Post-biopsy bleeding amounts were measured by soaking up the blood for five minutes. The results were compared using the Mann-Whitney U test. Results: The optimal parameters for biopsy tract ablation were determined as a 2-cm active tip electrode set at 40-watt with a tip temperature of $70-80^{\circ}C$. The bleeding amounts in all experimental groups were smaller than those in the controls; however they were significant in the non-heparinized pig biopsied with an 18-gauge needle and in two heparinized pigs (p < 0.001). In the heparinized pigs, the mean blood loss in the experimental group was 3.5% and 13.5% of the controls biopsied with an 18- and 16-gauge needle, respectively. Conclusion: Radiofrequency ablation of hepatic core biopsy tract ablation may reduce post-biopsy bleeding even under bleeding tendency and using a larger core needle, according to the result from in vivo porcine model experiments.

Keywords

Acknowledgement

Supported by : Samsung Medical Center

References

  1. Korean Liver Cancer Study Group (KLCSG); National Cancer Center, Korea (NCC). 2014 Korean Liver Cancer Study Group-National Cancer Center Korea practice guideline for the management of hepatocellular carcinoma. Korean J Radiol 2015;16:465-522 https://doi.org/10.3348/kjr.2015.16.3.465
  2. Ma X, Arellano RS, Gervais DA, Hahn PF, Mueller PR, Sahani DV. Success of image-guided biopsy for small ($\leq$ 3 cm) focal liver lesions in cirrhotic and noncirrhotic individuals. J Vasc Interv Radiol 2010;21:1539-1547; quiz 1547 https://doi.org/10.1016/j.jvir.2010.05.025
  3. Sporea I, Gherhardt D, Popescu A, Sirli R, Cornianu M, Herman D, et al. Does the size of the needle influence the number of portal tracts obtained through percutaneous liver biopsy? Ann Hepatol 2012;11:691-695
  4. McAfee JH, Keeffe EB, Lee RG, Rosch J. Transjugular liver biopsy. Hepatology 1992;15:726-732 https://doi.org/10.1002/hep.1840150429
  5. Allison DJ, Adam A. Percutaneous liver biopsy and track embolization with steel coils. Radiology 1988;169:261-263 https://doi.org/10.1148/radiology.169.1.3420270
  6. Falstrom JK, Moore MM, Caldwell SH, Matsumoto AH, Abbott RD, Spotnitz WD. Use of fibrin sealant to reduce bleeding after needle liver biopsy in an anticoagulated canine model: work in progress. J Vasc Interv Radiol 1999;10:457-462 https://doi.org/10.1016/S1051-0443(99)70065-5
  7. Fandrich CA, Davies RP, Hall PM. Small gauge gelfoam plug liver biopsy in high risk patients: safety and diagnostic value. Australas Radiol 1996;40:230-234 https://doi.org/10.1111/j.1440-1673.1996.tb00392.x
  8. Paulson EK, Stephenson GR, Neal MC, Rossin V, Lawson JH. Use of fibrin sealant as a hemostatic agent after liver biopsy in swine. J Vasc Interv Radiol 2000;11:905-911 https://doi.org/10.1016/S1051-0443(07)61810-7
  9. Smith TP, McDermott VG, Ayoub DM, Suhocki PV, Stackhouse DJ. Percutaneous transhepatic liver biopsy with tract embolization. Radiology 1996;198:769-774 https://doi.org/10.1148/radiology.198.3.8628869
  10. Zins M, Vilgrain V, Gayno S, Rolland Y, Arrive L, Denninger MH, et al. US-guided percutaneous liver biopsy with plugging of the needle track: a prospective study in 72 high-risk patients. Radiology 1992;184:841-843 https://doi.org/10.1148/radiology.184.3.1509076
  11. Bruners P, Penzkofer T, Isfort P, Pfeffer J, Schmitz-Rode T, Gunther RW, et al. A trucut biopsy needle for bipolar radiofrequency ablation of needle tract: a proof-of-concept experiment. Eur Radiol 2010;20:2000-2004 https://doi.org/10.1007/s00330-010-1739-1
  12. Laeseke PF, Winter TC 3rd, Davis CL, Stevens KR, Johnson CD, Fronczak FJ, et al. Postbiopsy bleeding in a porcine model: reduction with radio-frequency ablation--preliminary results. Radiology 2003;227:493-499 https://doi.org/10.1148/radiol.2272020173
  13. Pritchard WF, Wray-Cahen D, Karanian JW, Hilbert S, Wood BJ. Radiofrequency cauterization with biopsy introducer needle. J Vasc Interv Radiol 2004;15(2 Pt 1):183-187 https://doi.org/10.1097/01.RVI.000019398.74740.69
  14. Choi SH, Lee JM, Lee KH, Kim SH, Lee JY, Han JK, et al. Postbiopsy splenic bleeding in a dog model: comparison of cauterization, embolization, and plugging of the needle tract. AJR Am J Roentgenol 2005;185:878-884 https://doi.org/10.2214/AJR.04.1395
  15. Kang TW, Lim HK, Lee MW, Kim YS, Choi D, Rhim H. First-line radiofrequency ablation with or without artificial ascites for hepatocellular carcinomas in a subcapsular location: local control rate and risk of peritoneal seeding at long-term follow-up. Clin Radiol 2013;68:e641-e651 https://doi.org/10.1016/j.crad.2013.07.008
  16. Nahum Goldberg S, Dupuy DE. Image-guided radiofrequency tumor ablation: challenges and opportunities--part I. J Vasc Interv Radiol 2001;12:1021-1032 https://doi.org/10.1016/S1051-0443(07)61587-5
  17. 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
  18. Zervas NT, Kuwayama A. Pathological characteristics of experimental thermal lesions. Comparison of induction heating and radiofrequency electrocoagulation. J Neurosurg 1972;37:418-422 https://doi.org/10.3171/jns.1972.37.4.0418
  19. Chan SL, Wong AM, Lee K, Wong N, Chan AK. Personalized therapy for hepatocellular carcinoma: where are we now? Cancer Treat Rev 2016;45:77-86 https://doi.org/10.1016/j.ctrv.2016.02.008
  20. Zhang B, Finn RS. Personalized clinical trials in hepatocellular carcinoma based on biomarker selection. Liver Cancer 2016;5:221-232 https://doi.org/10.1159/000367763
  21. Chang S, Kim SH, Lim HK, Kim SH, Lee WJ, Choi D, et al. Needle tract implantation after percutaneous interventional procedures in hepatocellular carcinomas: lessons learned from a 10-year experience. Korean J Radiol 2008;9:268-274 https://doi.org/10.3348/kjr.2008.9.3.268
  22. Kim JW, Shin SS, Heo SH, Hong JH, Lim HS, Seon HJ, et al. Ultrasound-guided percutaneous radiofrequency ablation of liver tumors: how we do it safely and completely. Korean J Radiol 2015;16:1226-1239 https://doi.org/10.3348/kjr.2015.16.6.1226

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