Evaluation of the viability of hepatocellular carcinoma in the caudate lobe using contrast-enhanced endoscopic ultrasonography after transarterial chemoembolization

Abstract

A 71-year-old female was diagnosed with hepatocellular carcinoma (HCC). The tumor measured 65 mm in diameter and was located in the caudate lobe. Transarterial chemoembolization (TACE) was performed repeatedly; however, a follow-up dynamic computed tomography (CT) scan showed that the tumor remained viable. Thus, TACE was performed using drug-eluting beads that had been preloaded with epirubicin. Contrast-enhanced endoscopic ultrasonography (CE-EUS) was conducted for evaluating the treatment effects. First, we detected the internal part of the tumor. Then, a perflubutane suspension was injected intravenously. Next, CE-EUS was performed for the external ventral part of the tumor in the same manner. The perflubutane flowed into the tumor and spread into both its internal and external ventral regions. Thus, we considered that the tumor was still viable and planned to carry out TACE again. CE-EUS could be a useful tool for evaluating the treatment effects of TACE on HCC deep inside the liver.

EUS liver assessment using contrast agents and elastography

“…The CH-EUS study of the liver could be divided in three different phases: the arterial phase, starting few seconds after the injection and lasting for 30 s; the portal phase (from 30 to 120 s); and the late, venous phase (after 120 s from injection). [ 4 30 31 ]…”

Endoscopic ultrasound guided hepatic interventions

“…CEH-EUS has been applied to a lesion in the caudate lobe, which was difficult to assess with percutaneous CE-US. 74…”

“…The role of EUS in the diagnosis of liver lesions has not been standardized at this point. EUS‐FNA/FNB is useful in the diagnosis of focal liver lesions, metastatic lesions, early HCC, and evaluation of perihepatic adenopathy 59–85 . Some studies reported that EUS had better accuracy than US, CT and MRI, 65–67 although we need to be careful in extrapolating these older data to current high‐resolution imaging with CT and MRI.…”

The role of EUS in diagnosis and treatment of liver disorders

“…It can dynamically observe tumor vessel perfusion with superior diagnostic performance for residual tumors after transarterial chemoembolization (TACE) compared to CE-CT (sensitivity and accuracy of detecting residual tumor with CE-US 95.6 % and 96.2 % versus CE-CT 76.2 % and 77.7 %, respectively) 29 . For this particular indication, CE-EUS could be of value, with the advantage of better examining the deeper liver lesions not visualized with CE-US 30 . However, this needs further confirmation.…”