Xiao-Yu Yin

Percutaneous microwave and radiofrequency ablation for hepatocellular carcinoma: a retrospective comparative study.

BackgroundPercutaneous microwave ablation and radiofrequency ablation are two commonly used modalities for the treatment of hepatocellular carcinoma; however, comparisons of them have not been documented adequately.MethodsOf 102 patients with biopsy-proved hepatocellular carcinoma, 49 (98 nodules) were treated percutaneously with microwave ablation and 53 (72 nodules) with radiofrequency ablation. The local tumor control, complications related to treatment, and long-term results of the two modalities were compared retrospectively.ResultsThe complete ablation rates were 94.9% (93/98) using microwave ablation vs 93.1% (67/72) using radiofrequency ablation (P = 0.75), and no significant differences were found either in the ablation of tumors of 3.0u2009cm or less (P = 1.00) or in those of more than 3.0u2009cm (P = 1.00) between the two modalities. The local recurrence rates were 11.8% (11/93) using microwave ablation vs 20.9% (14/67) using radiofrequency ablation (P = 0.12), and there were no significant differences between the two modalities either in tumors of 3.0u2009cm or less (P = 0.36) or in those of more than 3.0u2009cm (P = 0.82). The rates of major complications associated with microwave ablation and radiofrequency ablation were 8.2% (4/49) vs 5.7% (3/53; P = 0.71). The disease-free survival rates in the microwave ablation group were 45.9%, 26.9%, 26.9%, and 13.4% at 1, 2, 3, and 4 years, respectively, and those in the radiofrequency ablation group were 37.2%, 20.7%, and 15.5% at 1, 2 and 3 years, respectively (P = 0.53). The 1-, 2-, 3-, and 4-year cumulative survival rates for patients who underwent microwave ablation were 81.6%, 61.2%, 50.5%, and 36.8%, respectively, and for patients who underwent radiofrequency ablation the rates were 71.7%, 47.2%, 37.6%, and 24.2%, respectively (P = 0.12).ConclusionsPercutaneous microwave ablation and radiofrequency ablation are both effective methods in treating hepatocellular carcinomas. The local tumor control, complications related to treatment, and long-term survivals were equivalent for the two modalities.

Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors.

Radiofrequency ablation (RFA) and microwave ablation (MWA) were found to be effective in treating hepatocellular carcinoma (HCC) smaller than 3 cm; however, to the authors knowledge, the usefulness of thermal ablation in treating larger HCC, especially those >5 cm, has not been well documented. The present study evaluated the therapeutic efficacy of percutaneous thermal ablation with curative intention for HCC measuring between 3.0 cm and 7.0 cm.

Percutaneous thermal ablation for recurrent hepatocellular carcinoma after hepatectomy

Tumour ablation using a thermal energy source has shown promising results, and is particularly suitable for recurrent hepatocellular carcinoma (HCC). The present study evaluated long‐term outcomes after percutaneous thermal ablation for recurrent HCC following liver resection.

ESTIMATION OF LIVER TUMOR VOLUME USING A THREE- DIMENSIONAL ULTRASOUND VOLUMETRIC SYSTEM

The usefulness of a new three-dimensional ultrasound (3DUS) volumetric system developed recently was validated in volume measurement of liver tumor in the present study. The system was used to estimate the volumes of 22 regular phantoms, 25 irregular phantoms and 37 liver tumors from 33 patients. The results showed that the consumed time of measurement with the system ranged from 1 to 15 min, depending on different rotation angles. The measured volumes at different rotation angles all significantly correlated with the true volumes and there were no significant differences among measured volumes at different angles. The measurement error of 3DUS was 0.3% +/- 3.3% in regular phantoms, -0.4% +/- 3.7% in irregular phantoms and 0.9% +/- 11.3% in liver tumors, respectively, as compared with -5.3 +/- 9.4%, 13.6 +/- 28.0% and 15.3 +/- 37.3% for two-dimensional ultrasound, respectively (all p < 0.05). The volume estimation with 3DUS also had significant intraobserver and interobserver reproducibility both in vitro and in vivo. It can be concluded that the new system that we used can greatly reduce the consumed time and manual labor for volume measurement with high accuracy and reproducibility. 3DUS volumetry using the new system is more acceptable and valuable in clinical practice and is expected to be useful for evaluation of the efficacy of tumor therapy in situ in patients with hepatic tumors.

Usefulness of three-dimensional sonography in procedures of ablation for liver cancers: initial experience.

Objective. To investigate the usefulness of three‐dimensional sonography in procedures of ablation for liver cancers. Methods. Two‐ and three‐dimensional sonography were used in guiding 18 chemical ablation procedures (7 with boiling carboplatin ablation and 11 with ethanol ablation) and 21 radio frequency ablation procedures for treatment of liver cancers. The applicator conspicuity depicted by the 2 imaging modalities, the confidence level of the operator in determining the position relationship between the applicator and the tumor using the 2 imaging modalities, and the alteration of ablation procedures were evaluated. Results. Three‐dimensional sonography was better than two‐dimensional sonography in delineation of multitined, expandable electrode tips in radio frequency ablation procedures, whereas the 2 modalities were equal in depicting percutaneous transhepatic cholangiography needle tips in chemical ablation procedures. Three‐dimensional sonography significantly enhanced the confidence level in defining the spatial relationship between applicator and tumor in comparison with two‐dimensional sonography (P < .01). Suboptimal applicator placement was detected in 6 (15%) of 39 ablation procedures on three‐dimensional sonography: 3 chemical ablation procedures and 3 radio frequency ablation procedures. Applicator adjustment was required in 3 chemical ablation procedures. In 15 (38%) of 39 procedures, three‐dimensional sonography allowed better visualization of the position relationship between the applicator and adjacent critical structures. Conclusions. Three‐dimensional sonography was useful in delineation of expandable radio frequency electrodes, improvement of operator confidence level, determination of applicator placement, and visualization of the position relationship between the applicator and adjacent critical structures during procedures of liver cancer ablation under image guidance.

Comparison of Three- and Two-dimensional Sonography in Diagnosis of Gallbladder Diseases Preliminary Experience

Objective. To compare three‐dimensional sonography with two‐dimensional sonography for diagnosis of gallbladder diseases. Methods. Sixty‐three patients with gallbladder diseases were examined with two‐ and three‐dimensional sonography. The morphologic features presented on both modalities were analyzed, and the diagnostic accuracies of both modalities were evaluated and compared. Results. Both two‐ and three‐dimensional sonography facilitated correct diagnosis in all patients with gallstones. Three‐dimensional sonography had no influence on the diagnosis of gallstones compared with two‐dimensional sonography. Three‐dimensional sonography showed the granular surfaces in 18 (81.8%) of 22 cases of polypoid lesions and the pedunculated fundus in 19 (86.4%) of 22, whereas two‐dimensional sonography displayed them in 10 (45.5%) and 3 (13.6%) of 22, respectively (P < .05 and .001). Three‐ and two‐dimensional sonography made correct differential diagnoses between non‐neoplastic and neoplastic polyps in 20 (90.9%) and 12 (54.5%) of 22, respectively (P < .05). In gallbladder carcinoma, both three‐ and two‐dimensional sonography accurately showed all the associated gallstones and intrahepatic bile duct dilatation. Two‐dimensional sonography could not correctly define the locations of the lesions in 2 (28.6%) and tumor extension in 1 (14.3%) of 7 cases with pathologically proved gallbladder cancer, whereas three‐dimensional sonography improved the diagnosis in these cases. Conclusions. Three‐dimensional sonography adds no advantages for diagnosis of gallstones compared with two‐dimensional sonography, but it is better than two‐dimensional sonography for differential diagnosis of gallbladder polyps and may improve the localization and staging for gallbladder carcinoma; however, additional studies are needed for further determination.

Value of Contrast-Enhanced Ultrasonography in Assessing the Vascularity of Liver Metastases Comparison With Contrast-Enhanced Computed Tomography

Objective. The purpose of this study was to compare the capability of contrast‐enhanced ultrasonog‐raphy (CEUS) and contrast‐enhanced computed tomography (CECT) in evaluating the vascularity of liver metastases. Methods. Both CEUS and CECT examinations were performed on 70 patients with liver metastases, which were from colon carcinoma in 31, rectal carcinoma in 17, pancreatic carcinoma in 5, and others in 17. In patients with multiple lesions, the most easily observed lesion was selected as the target lesion for evaluation of vascularity. Results. Peak enhancement of the target lesion during the arterial phase was characterized as hyperenhancement, isoenhancement, hypo‐enhancement, and nonenhancement in 61 (87.1%), 6 (8.6%), 3 (4.3%), and 0 (0%) patients on CEUS, respectively, and in 52 (74.3%), 8 (11.4%), 8 (11.4%), and 2 (2.9%) on CECT. Contrast‐enhanced ultrasonography showed more lesions with hyperenhancement than CECT (P < .01). The enhancement pattern during the arterial phase was homogeneous, inhomogeneous, and rimlike in 30 (42.9%), 16 (22.9%), and 24 (34.2%) patients on CEUS and in 13 (18.6%), 8 (11.4%), and 49 (70%) on CECT. Contrast‐enhanced ultrasonography revealed more lesions with homogeneous enhancement than CECT (P < .01). Contrast‐enhanced ultrasonography showed dysmorphic vessels in 33 patients (47.1%) during the arterial phase, whereas CECT showed dysmorphic vessels in 27 (38.6%; P < .01). Contrast‐enhanced ultrasonography showed hypervascular lesions in 58.6% of patients, whereas CECT showed hypervascular lesions in 12.9% (P < .01). Conclusions. Contrast‐enhanced ultrasonography was superior to CECT in assessing the vascularity of liver metastases.

Three-dimensional Gray Scale Volume Rendering of the Liver Preliminary Clinical Experience

Objective. To investigate the potential clinical usefulness of three‐dimensional gray scale volume rendering in the liver. Methods. Sixty‐two patients were enrolled in the study and categorized into 2 groups: group I with ascites and group II without. Two types of volume‐rendering modes, i.e., surface and transparent, were used to obtain the three‐dimensional images. The data were reviewed to identify the differences between two‐ and three‐dimensional images of the liver in each subject. Results. In group I, three‐dimensional sonography was superior to two‐dimensional sonography in terms of surface features, edges, overall three‐dimensional impression, image clarity, and structural relationships. However, it seemed that three‐dimensional sonography in the surface mode was inferior to two‐dimensional sonography in showing intrahepatic structures, because it had decreased resolution. In group II, three‐dimensional sonography was superior to two‐dimensional sonography with respect to the continuity of intrahepatic vessels, overall three‐dimensional impression of the vessels, image clarity, and the relationship between lesions and neighboring vessels. However, the resolution of the lesions was decreased in 7 cases of hepatocellular carcinoma. Conclusions. Our experience suggests that three‐dimensional gray scale volume rendering of the liver provides more diagnostic information than two‐dimensional sonography; however, further studies are needed to evaluate its clinical importance.

Percutaneous Ablative Therapies of Recurrent Hepatocellular Carcinoma after Hepatectomy: Proposal of a Prognostic Model

BackgroundPercutaneous ablative therapies (PAT) are valuable modalities for posthepatectomy recurrent hepatocellular carcinoma (RHCC), but its impact on long-term outcome and prognosis prediction have not been well documented. The present study aimed to analyze prognostic factors and to propose a prognosis-predicting model for RHCC treated with PAT.MethodsA total of 288 patients with posthepatectomy RHCC treated with percutaneous ethanol ablation, radiofrequency ablation, microwave ablation, or ethanol ablation combined with radiofrequency ablation were included. Survival and prognostic factors were analyzed. A prognosis-predicting model was created by quantifying and integrating all prognostic factors.ResultsThree-, 5-, and 7-year postablation survival rates were 37.8, 20.7, and 14.2xa0%, respectively. Multivariate analysis revealed that interval between recurrence and initial hepatectomy, tumor number, largest diameter of tumor, and Barcelona Clinic Liver Cancer stage at hepatectomy were independent prognostic factors for survival. A scoring system for prognostic factors was proposed, and summation of 4 prognostic factors (prognostic score) was ranged from 4 to 10. Prognostic score was classified into three strata, designated as prognostic classes A (score 4 and 5), B (score 6 and 7), and C (≥8). Three-, 5-, and 7-year postablation survival rates were 62.8, 39.4, and 26.9xa0% in class A, 36.9, 15.5, and 7.2xa0% in B, and 5.5, 0, and 0xa0% in class C, respectively (pxa0=xa00.00). Three-, 5-, 7-, and 10-year survival rates after initial hepatectomy were 82.4, 66.3, 52.1, and 36.4xa0% in class A, 51.6, 34.8, 20.7, and 6.6xa0% in class B, and 11.9, 7.8, 0, and 0xa0% in class C, respectively (pxa0=xa00.00).ConclusionsThe prognostic model developed in the study could clearly predict different long-term outcomes for patients with posthepatectomy RHCC and thus help decide appropriate therapeutic strategy.