Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
권호 표지
DOI QR코드

DOI QR Code

Percutaneous Dual-Switching Monopolar Radiofrequency Ablation Using a Separable Clustered Electrode: A Preliminary Study

  • Choi, Tae Won (Department of Radiology, Seoul National University Hospital) ;
  • Lee, Jeong Min (Department of Radiology, Seoul National University Hospital) ;
  • Lee, Dong Ho (Department of Radiology, Seoul National University Hospital) ;
  • Lee, Jeong-Hoon (Institute of Radiation Medicine, Seoul National University Hospital) ;
  • Yu, Su Jong (Institute of Radiation Medicine, Seoul National University Hospital) ;
  • Kim, Yoon Jun (Institute of Radiation Medicine, Seoul National University Hospital) ;
  • Yoon, Jung-Hwan (Institute of Radiation Medicine, Seoul National University Hospital) ;
  • Han, Joon Koo (Department of Radiology, Seoul National University Hospital)
  • Received : 2016.08.04
  • Accepted : 2017.03.04
  • Published : 2017.10.01
⟨ Previous Next ⟩

Abstract

Objective: To prospectively evaluate the safety and therapeutic effectiveness of dual-switching monopolar (DSM) radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC), and to retrospectively compare the results with those of single-switching monopolar (SSM) RFA in a historical control group. Materials and Methods: This study was approved by the Institutional Review Board, with informed consent obtained from all patients. Fifty-two HCC patients who underwent DSM-RFA using a separable clustered electrode and dual-generators were prospectively enrolled. Technical parameters, complications, technical success, technical effectiveness, and local tumor progression (LTP) rates were evaluated by means of post-procedural and follow-up imaging. Thereafter, the outcome of DSM-RFA was compared with those of 249 retrospectively included HCC patients treated with SSM-RFA. Results: There were two major complications (3.8%, 2/52) including pleural and pericardial effusion in the DSM-RFA group. The DSM-RFA yielded a 100% technical success rate, a 98.1% technical effectiveness rate, and a 4.3% 2-year LTP rate. In a retrospective comparison between the two groups, DSM-RFA created significantly larger ablation volume ($4.20{\pm}2.07cm^3/min$ vs. $3.03{\pm}1.99cm^3/min$, p < 0.01), and delivered higher energy ($1.43{\pm}0.37kcal/min$ vs. $1.25{\pm}0.50kcal/min$, p < 0.01) per vs. $3.03{\pm}1.99cm^3/min$, p < 0.01), and delivered higher energy ($1.43{\pm}0.37kcal/min$ vs. $1.25{\pm}0.50kcal/min$, p < 0.01) per given time, than SSM-RFA. There was no significant difference in major procedure-related complications (3.8% vs. 4.4%) and technical effectiveness rate (98.1% vs. 96.4%) between the two groups (p = 1.00). In addition, the 2-year LTP rate of DSM-RFA and SSM-RFA were 4.3% and 10.1%, respectively (p = 0.15). Conclusion: DSM-RFA using a separable clustered electrode is safe and provides high local tumor control and good preliminary clinical outcome for small HCCs, which are at least comparable to those of SSM-RFA.

Keywords

Acknowledgement

Supported by : STARmed Co.

References

  1. 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
  2. Pompili M, Saviano A, de Matthaeis N, Cucchetti A, Ardito F, Federico B, et al. Long-term effectiveness of resection and radiofrequency ablation for single hepatocellular carcinoma $\leq$3 cm. Results of a multicenter Italian survey. J Hepatol 2013;59:89-97 https://doi.org/10.1016/j.jhep.2013.03.009
  3. 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
  4. Yu SJ. A concise review of updated guidelines regarding the management of hepatocellular carcinoma around the world: 2010-2016. Clin Mol Hepatol 2016;22:7-17 https://doi.org/10.3350/cmh.2016.22.1.7
  5. Ruzzenente A, Guglielmi A, Sandri M, Campagnaro T, Valdegamberi A, Conci S, et al. Surgical resection versus local ablation for HCC on cirrhosis: results from a propensity case-matched study. J Gastrointest Surg 2012;16:301-311; discussion 311 https://doi.org/10.1007/s11605-011-1745-x
  6. Montorsi M, Santambrogio R, Bianchi P, Donadon M, Moroni E, Spinelli A, et al. Survival and recurrences after hepatic resection or radiofrequency for hepatocellular carcinoma in cirrhotic patients: a multivariate analysis. J Gastrointest Surg 2005;9:62-67; discussion 67-68 https://doi.org/10.1016/j.gassur.2004.10.003
  7. 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
  8. 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
  9. Kim KW, Lee JM, Klotz E, Kim SJ, Kim SH, Kim JY, et al. Safety margin assessment after radiofrequency ablation of the liver using registration of preprocedure and postprocedure CT images. AJR Am J Roentgenol 2011;196:W565-W572 https://doi.org/10.2214/AJR.10.5122
  10. Pereira PL. Actual role of radiofrequency ablation of liver metastases. Eur Radiol 2007;17:2062-2070 https://doi.org/10.1007/s00330-007-0587-0
  11. Ni Y, Mulier S, Miao Y, Michel L, Marchal G. A review of the general aspects of radiofrequency ablation. Abdom Imaging 2005;30:381-400 https://doi.org/10.1007/s00261-004-0253-9
  12. 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
  13. Lee J, Lee JM, Yoon JH, Lee JY, Kim SH, Lee JE, et al. Percutaneous radiofrequency ablation with multiple electrodes for medium-sized hepatocellular carcinomas. Korean J Radiol 2012;13:34-43 https://doi.org/10.3348/kjr.2012.13.1.34
  14. Lee JM, Han JK, Kim HC, Choi YH, Kim SH, Choi JY, et al. Switching monopolar radiofrequency ablation technique using multiple, internally cooled electrodes and a multichannel generator: ex vivo and in vivo pilot study. Invest Radiol 2007;42:163-171 https://doi.org/10.1097/01.rli.0000252495.44818.b3
  15. 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
  16. Lee ES, Lee JM, Kim WS, Choi SH, Joo I, Kim M, et al. Multiple-electrode radiofrequency ablations using $Octopus^{(R)}$ electrodes in an in vivo porcine liver model. Br J Radiol 2012;85:e609-e615 https://doi.org/10.1259/bjr/61619687
  17. Park MJ, Kim YS, Rhim H, Lim HK, Lee MW, Choi D. A comparison of US-guided percutaneous radiofrequency ablation of medium-sized hepatocellular carcinoma with a cluster electrode or a single electrode with a multiple overlapping ablation technique. J Vasc Interv Radiol 2011;22:771-779 https://doi.org/10.1016/j.jvir.2011.02.005
  18. Weisbrod AJ, Atwell TD, Callstrom MR, Farrell MA, Mandrekar JN, Charboneau JW. Percutaneous radiofrequency ablation with a multiple-electrode switching-generator system. J Vasc Interv Radiol 2007;18:1528-1532 https://doi.org/10.1016/j.jvir.2007.08.004
  19. 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
  20. 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
  21. Mitchell DG, Bruix J, Sherman M, Sirlin CB. LI-RADS (Liver Imaging Reporting and Data System): summary, discussion, and consensus of the LI-RADS Management Working Group and future directions. Hepatology 2015;61:1056-1065 https://doi.org/10.1002/hep.27304
  22. Hope TA, Fowler KJ, Sirlin CB, Costa EA, Yee J, Yeh BM, et al. Hepatobiliary agents and their role in LI-RADS. Abdom Imaging 2015;40:613-625 https://doi.org/10.1007/s00261-014-0227-5
  23. Lee MW. Fusion imaging of real-time ultrasonography with CT or MRI for hepatic intervention. Ultrasonography 2014;33:227-239 https://doi.org/10.14366/usg.14021
  24. Min JH, Lim HK, Lim S, Kang TW, Song KD, Choi SY, et al. Radiofrequency ablation of very-early-stage hepatocellular carcinoma inconspicuous on fusion imaging with B-mode US: value of fusion imaging with contrast-enhanced US. Clin Mol Hepatol 2014;20:61-70 https://doi.org/10.3350/cmh.2014.20.1.61
  25. 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
  26. Kudo M, Matsui O, Izumi N, Iijima H, Kadoya M, Imai Y, et al. JSH consensus-based clinical practice guidelines for the management of hepatocellular carcinoma: 2014 update by the Liver Cancer Study Group of Japan. Liver Cancer 2014;3:458-468 https://doi.org/10.1159/000343875
  27. 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
  28. Sacks D, McClenny TE, Cardella JF, Lewis CA. Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 2003;14(9 Pt 2):S199-S202 https://doi.org/10.1097/01.RVI.0000094584.83406.3e
  29. Iezzi R, Pompili M, Posa A, Coppola G, Gasbarrini A, Bonomo L. Combined locoregional treatment of patients with hepatocellular carcinoma: state of the art. World J Gastroenterol 2016;22:1935-1942 https://doi.org/10.3748/wjg.v22.i6.1935
  30. Hyun D, Cho SK, Shin SW, Park KB, Park HS, Choo SW, et al. Early stage hepatocellular carcinomas not feasible for ultrasound-guided radiofrequency ablation: comparison of transarterial chemoembolization alone and combined therapy with transarterial chemoembolization and radiofrequency ablation. Cardiovasc Intervent Radiol 2016;39:417-425 https://doi.org/10.1007/s00270-015-1194-0
  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. J Vasc Interv Radiol 2014;25:1691-1705.e4 https://doi.org/10.1016/j.jvir.2014.08.027
  32. 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
  33. Jun HY, Ryu JH, Byun SJ, Jeong CW, Kim TH, Lee YH, et al. Combined radiofrequency ablation and double anti-angiogenic protein therapy to increase coagulation efficacy: an experimental study in a murine renal carcinoma model. Korean J Radiol 2015;16:776-782 https://doi.org/10.3348/kjr.2015.16.4.776
  34. 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
  35. Rhim H. Complications of radiofrequency ablation in hepatocellular carcinoma. Abdom Imaging 2005;30:409-418 https://doi.org/10.1007/s00261-004-0255-7
  36. 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
  37. 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
  38. Seror O, N'Kontchou G, Ibraheem M, Ajavon Y, Barrucand C, Ganne N, et al. Large (>or=5.0-cm) HCCs: multipolar RF ablation with three internally cooled bipolar electrodes--initial experience in 26 patients. Radiology 2008;248:288-296 https://doi.org/10.1148/radiol.2481071101
  39. Bruners P, Schmitz-Rode T, Gunther RW, Mahnken A. Multipolar hepatic radiofrequency ablation using up to six applicators: preliminary results. Rofo 2008;180:216-222 https://doi.org/10.1055/s-2008-1027184
  40. Bhattacharya A, Mittal BR, Biswas T, Dhiman RK, Singh B, Jindal SK, et al. Radioisotope scintigraphy in the diagnosis of hepatic hydrothorax. J Gastroenterol Hepatol 2001;16:317-321 https://doi.org/10.1046/j.1440-1746.2001.02441.x
  41. Koda M, Murawaki Y, Hirooka Y, Kitamoto M, Ono M, Sakaeda H, et al. Complications of radiofrequency ablation for hepatocellular carcinoma in a multicenter study: an analysis of 16346 treated nodules in 13283 patients. Hepatol Res 2012;42:1058-1064 https://doi.org/10.1111/j.1872-034X.2012.01025.x

Cited by

  1. Percutaneous thermal ablation of hepatocellular carcinomas located in the hepatic dome using artificial carbon dioxide pneumothorax: retrospective evaluation of safety and efficacy vol.35, pp.1, 2017, https://doi.org/10.1080/02656736.2018.1477206
  2. Recent Advances in the Image-Guided Tumor Ablation of Liver Malignancies: Radiofrequency Ablation with Multiple Electrodes, Real-Time Multimodality Fusion Imaging, and New Energy Sources vol.19, pp.4, 2018, https://doi.org/10.3348/kjr.2018.19.4.545
  3. Sequential and Simultaneous 4-Antenna Microwave Ablation in an Ex Vivo Bovine Liver Model vol.42, pp.10, 2019, https://doi.org/10.1007/s00270-019-02241-6
  4. Radiofrequency Ablation Using a Separable Clustered Electrode for the Treatment of Hepatocellular Carcinomas: A Randomized Controlled Trial of a Dual-Switching Monopolar Mode Versus a Single-Switching vol.21, pp.None, 2017, https://doi.org/10.3348/kjr.2020.0134
  5. Switching Monopolar No-Touch Radiofrequency Ablation Using Octopus Electrodes for Small Hepatocellular Carcinoma: A Randomized Clinical Trial vol.10, pp.1, 2021, https://doi.org/10.1159/000512338
  6. Comparison of ablation performance between dual internally cooled wet tip and conventional dual internally cooled tip radiofrequency electrodes: an experimental study in ex vivo bovine liver vol.38, pp.1, 2017, https://doi.org/10.1080/02656736.2021.1876255
  7. Linear radiofrequency ablation using dual switching-control mode achieves rapid and bloodless liver resection, an experimental research vol.38, pp.1, 2017, https://doi.org/10.1080/02656736.2021.1892215
  8. Optimizing Loco Regional Management of Oligometastatic Colorectal Cancer: Technical Aspects and Biomarkers, Two Sides of the Same Coin vol.13, pp.11, 2017, https://doi.org/10.3390/cancers13112617
  9. Recent technical advances in radiofrequency ablations for hepatocellular carcinoma vol.10, pp.4, 2017, https://doi.org/10.18528/ijgii210050