Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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No-Touch Radiofrequency Ablation: A Comparison of Switching Bipolar and Switching Monopolar Ablation in Ex Vivo Bovine Liver

  • Chang, Won (Department of Radiology, Seoul National University Hospital) ;
  • Lee, Jeong Min (Department of Radiology, Seoul National University Hospital) ;
  • Lee, Sang Min (Department of Radiology, Seoul National University Hospital) ;
  • Han, Joon Koo (Department of Radiology, Seoul National University Hospital)
  • Received : 2016.08.20
  • Accepted : 2016.10.12
  • Published : 2017.04.01
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Abstract

Objective: To evaluate the feasibility, efficiency, and safety of no-touch switching bipolar (SB) and switching monopolar (SM) radiofrequency ablation (RFA) using ex vivo bovine livers. Materials and Methods: A pork loin cube was inserted as a tumor mimicker in the bovine liver block; RFA was performed using the no-touch technique in the SM (group A1; 10 minutes, n = 10, group A2; 15 minutes, n = 10) and SB (group B; 10 minutes, n = 10) modes. The groups were compared based on the creation of confluent necrosis with sufficient safety margins, the dimensions, and distance between the electrode and ablation zone margin (DEM). To evaluate safety, small bowel loops were placed above the liver surface and 30 additional ablations were performed in the same groups. Results: Confluent necroses with sufficient safety margins were created in all specimens. SM RFA created significantly larger volumes of ablation compared to SB RFA (all p < 0.001). The DEM of group B was significantly lower than those of groups A1 and A2 (all p < 0.001). Although thermal injury to the small bowel was noted in 90%, 100%, and 30% of the cases in groups A1, A2, and B, respectively, full depth injury was noted only in 60% of group A2 cases. Conclusion: The no-touch RFA technique is feasible in both the SB and SM modes; however, SB RFA appears to be more advantageous compared to SM RFA in the creation of an ablation zone while avoiding the unnecessary creation of an adjacent parenchymal ablation zone or adjacent small bowel injuries.

Keywords

Acknowledgement

Supported by : STARmed Co.

References

  1. Bruix J, Sherman M; American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology 2011;53:1020-1022 https://doi.org/10.1002/hep.24199
  2. European Association for the Study of the Liver; European Organisation for Research and Treatment of Cancer. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol 2012;56:908-943 https://doi.org/10.1016/j.jhep.2011.12.001
  3. Salhab M, Canelo R. An overview of evidence-based management of hepatocellular carcinoma: a meta-analysis. J Cancer Res Ther 2011;7:463-475 https://doi.org/10.4103/0973-1482.92023
  4. Wu YZ, Li B, Wang T, Wang SJ, Zhou YM. Radiofrequency ablation vs hepatic resection for solitary colorectal liver metastasis: a meta-analysis. World J Gastroenterol 2011;17:4143-4148 https://doi.org/10.3748/wjg.v17.i36.4143
  5. Chen MS, Li JQ, Zheng Y, Guo RP, Liang HH, Zhang YQ, et al. A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 2006;243:321-328 https://doi.org/10.1097/01.sla.0000201480.65519.b8
  6. Wang JH, Wang CC, Hung CH, Chen CL, Lu SN. Survival comparison between surgical resection and radiofrequency ablation for patients in BCLC very early/early stage hepatocellular carcinoma. J Hepatol 2012;56:412-418 https://doi.org/10.1016/j.jhep.2011.05.020
  7. Ahmed M, Brace CL, Lee FT Jr, Goldberg SN. Principles of and advances in percutaneous ablation. Radiology 2011;258:351-369 https://doi.org/10.1148/radiol.10081634
  8. Goldberg SN. Science to practice: which approaches to combination interventional oncologic therapy hold the greatest promise of obtaining maximal clinical benefit? Radiology 2011;261:667-669 https://doi.org/10.1148/radiol.111906
  9. Laeseke PF, Sampson LA, Haemmerich D, Brace CL, Fine JP, Frey TM, et al. Multiple-electrode radiofrequency ablation creates confluent areas of necrosis: in vivo porcine liver results. Radiology 2006;241:116-124 https://doi.org/10.1148/radiol.2411051271
  10. Lee JM, Han JK, Kim HC, Kim SH, Kim KW, Joo SM, et al. Multiple-electrode radiofrequency ablation of in vivo porcine liver: comparative studies of consecutive monopolar, switching monopolar versus multipolar modes. Invest Radiol 2007;42:676-683 https://doi.org/10.1097/RLI.0b013e3180661aad
  11. 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
  12. Wang X, Hu Y, Ren M, Lu X, Lu G, He S. Efficacy and safety of radiofrequency ablation combined with transcatheter arterial chemoembolization for hepatocellular carcinomas compared with radiofrequency ablation alone: a time-to-event metaanalysis. Korean J Radiol 2016;17:93-102 https://doi.org/10.3348/kjr.2016.17.1.93
  13. 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
  14. Hori T, Nagata K, Hasuike S, Onaga M, Motoda M, Moriuchi A, et al. Risk factors for the local recurrence of hepatocellular carcinoma after a single session of percutaneous radiofrequency ablation. J Gastroenterol 2003;38:977-981 https://doi.org/10.1007/s00535-003-1181-0
  15. Stigliano R, Marelli L, Yu D, Davies N, Patch D, Burroughs AK. Seeding following percutaneous diagnostic and therapeutic approaches for hepatocellular carcinoma. What is the risk and the outcome? Seeding risk for percutaneous approach of HCC. Cancer Treat Rev 2007;33:437-447 https://doi.org/10.1016/j.ctrv.2007.04.001
  16. Imamura J, Tateishi R, Shiina S, Goto E, Sato T, Ohki T, et al. Neoplastic seeding after radiofrequency ablation for hepatocellular carcinoma. Am J Gastroenterol 2008;103:3057-3062 https://doi.org/10.1111/j.1572-0241.2008.02153.x
  17. Snoeren N, Jansen MC, Rijken AM, van Hillegersberg R, Slooter G, Klaase J, et al. Assessment of viable tumour tissue attached to needle applicators after local ablation of liver tumours. Dig Surg 2009;26:56-62 https://doi.org/10.1159/000194946
  18. Park SI, Kim IJ, Lee SJ, Shin MW, Shin WS, Chung YE, et al. Angled cool-tip electrode for radiofrequency ablation of small superficial subcapsular tumors in the liver: a feasibility study. Korean J Radiol 2016;17:742-749 https://doi.org/10.3348/kjr.2016.17.5.742
  19. Seror O, N'Kontchou G, Van Nhieu JT, Rabahi Y, Nahon P, Laurent A, et al. Histopathologic comparison of monopolar versus no-touch multipolar radiofrequency ablation to treat hepatocellular carcinoma within Milan criteria. J Vasc Interv Radiol 2014;25:599-607 https://doi.org/10.1016/j.jvir.2013.11.025
  20. Wu LW, Chen CY, Liu CJ, Chen MY, Liu PC, Liu PF, et al. Multipolar radiofrequency ablation with non-touch technique for hepatocellular carcinoma ${\leq}$ 3 cm: a preliminary report. Adv Dig Med 2014;1:80-85 https://doi.org/10.1016/j.aidm.2013.09.004
  21. Hocquelet A, Aube C, Rode A, Cartier V, Sutter O, Manichon AF, et al. Comparison of no-touch multi-bipolar vs. monopolar radiofrequency ablation for small HCC. J Hepatol 2017;66:67-74 https://doi.org/10.1016/j.jhep.2016.07.010
  22. Seror O, N'Kontchou G, Nault JC, Rabahi Y, Nahon P, Ganne-Carrie N, et al. Hepatocellular carcinoma within Milan criteria: no-touch multibipolar radiofrequency ablation for treatment-long-term results. Radiology 2016;280:611-621 https://doi.org/10.1148/radiol.2016150743
  23. Lee JM, Kim SH, Han JK, Sohn KL, Choi BI. Ex vivo experiment of saline-enhanced hepatic bipolar radiofrequency ablation with a perfused needle electrode: comparison with conventional monopolar and simultaneous monopolar modes. Cardiovasc Intervent Radiol 2005;28:338-345 https://doi.org/10.1007/s00270-004-0177-3
  24. Osaki Y, Ikeda K, Izumi N, Yamashita S, Kumada H, Hatta S, et al. Clinical effectiveness of bipolar radiofrequency ablation for small liver cancers. J Gastroenterol 2013;48:874-883 https://doi.org/10.1007/s00535-012-0685-x
  25. Yoon JH, Lee JM, Woo S, Hwang EJ, Hwang I, Choi W, et al. Switching bipolar hepatic radiofrequency ablation using internally cooled wet electrodes: comparison with consecutive monopolar and switching monopolar modes. Br J Radiol 2015;88:20140468 https://doi.org/10.1259/bjr.20140468
  26. Lee FT Jr, Haemmerich D, Wright AS, Mahvi DM, Sampson LA, Webster JG. Multiple probe radiofrequency ablation: pilot study in an animal model. J Vasc Interv Radiol 2003;14:1437-1442 https://doi.org/10.1097/01.RVI.0000096771.74047.C8
  27. 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
  28. Kim YS, Rhim H, Cho OK, Koh BH, Kim Y. Intrahepatic recurrence after percutaneous radiofrequency ablation of hepatocellular carcinoma: analysis of the pattern and risk factors. Eur J Radiol 2006;59:432-441 https://doi.org/10.1016/j.ejrad.2006.03.007
  29. 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
  30. 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
  31. Ahmed M, Solbiati L, Brace CL, Breen DJ, Callstrom MR, Charboneau JW, et al. Image-guided tumor ablation: standardization of terminology and reporting criteria--a 10-year update. Radiology 2014;273:241-260 https://doi.org/10.1148/radiol.14132958
  32. Tulikangas PK, Smith T, Falcone T, Boparai N, Walters MD. Gross and histologic characteristics of laparoscopic injuries with four different energy sources. Fertil Steril 2001;75:806-810 https://doi.org/10.1016/S0015-0282(00)01785-4
  33. Martin KE, Moore CM, Tucker R, Fuchshuber P, Robinson T. Quantifying inadvertent thermal bowel injury from the monopolar instrument. Surg Endosc 2016;30:4776-4784 https://doi.org/10.1007/s00464-016-4807-z
  34. Pillai K, Akhter J, Chua TC, Shehata M, Alzahrani N, Al-Alem I, et al. Heat sink effect on tumor ablation characteristics as observed in monopolar radiofrequency, bipolar radiofrequency, and microwave, using ex vivo calf liver model. Medicine (Baltimore) 2015;94:e580 https://doi.org/10.1097/MD.0000000000000580
  35. Llovet JM, Vilana R, Bru 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
  36. Cabibbo G, Craxi A. Needle track seeding following percutaneous procedures for hepatocellular carcinoma. World J Hepatol 2009;1:62-66 https://doi.org/10.4254/wjh.v1.i1.62
  37. Kawamura Y, Ikeda K, Fukushima T, Hara T, Hosaka T, Kobayashi M, et al. Potential of a no-touch pincer ablation procedure for small hepatocellular carcinoma that uses a multipolar radiofrequency ablation system: an experimental animal study. Hepatol Res 2014;44:1234-1240 https://doi.org/10.1111/hepr.12240

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