Histopathological findings after ultraselective transcatheter arterial chemoembolization for hepatocellular carcinoma

Abstract

Ultraselective TACE induces not only complete tumor necrosis but also peritumoral parenchymal necrosis, similar to that after radiofrequency ablation, when the portal veins are markedly visualized during the TACE procedure.

Pseudolesion of the liver observed on gadoxetate disodium-enhanced magnetic resonance imaging obtained shortly after transarterial chemoembolization for hepatocellular carcinoma

“…8 This possibility might be less likely as a mechanism of these pseudolesions because their shapes (mass-or band-like) were not concordant with usual fan-or wedge-shaped portal perfusion; in addition, no portal venous thrombosis or portal perfusion abnormality was detected on the portal phase of the dynamic study in any of the three patients presented.…”

“…A possible mechanism of this phenomenon is as follows: TACE may affect normal liver tissue adjacent to the tumor by means of the combined effects of ischemia and antitumor agents, which may result in tissue infl ammation and damage to the liver cell function at the corresponding sites, sometimes including small foci of necrosis. 8 Hepatic arterial fl ow at these areas may be restored soon after TACE, possibly through several collateral circulations or simply by absorption of the embolic materials. 6 Furthermore, the infl ammatory process may cause hyperemia, 9 which shows up as enhancement at the arterial phase of the dynamic phase.…”

Prediction of Embolization Area after Conventional Transcatheter Arterial Chemoembolization for Hepatocellular Carcinoma Using SYNAPSE VINCENT

“…Furthermore, rotating images using 3D analysis software to recognize and identify feeding vessels is effective, as there are limitations to feeding vessel identification when using 2D imaging [22,23,24]. Selective injection of medication near the tumor has been reported to improve treatment effectiveness, in addition to being useful for preventing decreased hepatic residual capacity [12,13]. However, the fact that high-cost IVR-CT or CBCT machines were previously required for predicting embolized regions on 3D images, the frequent use of contrast medium, and increased radiation exposure are associated issues.…”

“…Ultraselective chemoembolization is an alternative approach to improve local control, and is associated with a reduced incidence of adverse effects [12,13,14]. …”

Treatment Options in Hepatocellular Carcinoma Today

“…TAE with small spherical embolic particles (25) and TACE with nonresorbable hydrogel drug-eluting beads (DEB) capable of being loaded with anthracyclin derivates such as doxorubicin, seem to offer such advantages. Another possibility is offered by advancements in microcatheter technology, which facilitates "ultraselective" catheterization of nodule feeders and the overflow of Lipiodol into the portal vein, a factor associated with lower local recurrence (26).…”