Needle track seeding following percutaneous procedures for hepatocellular carcinoma

Abstract

Neoplastic seeding may arise after diagnostic or therapeutic percutaneous procedures for hepatocellular carcinoma. The true incidence of seeding with hepatocellular carcinoma is difficult to assess precisely, but a significant risk of seeding exists and is greater when performing diagnostic biopsy as compared to therapeutic percutaneous procedures [radiofrequency ablation, radiofrequency ablation (RFA); percutaneous ethanol injection, Percutaneous ethanol injection (PEI)]. Whenever liver transplantation is feasible, diagnostic needle biopsies should be avoided, but RFA and PEI are often needed as "bridge" treatments. The role of adjuvant treatments in reducing the incidence of seeding following RFA or PEI requires further evaluation.

Results of laparoscopic radiofrequency ablation for HCC. Could the location of the tumour influence a complete response to treatment? A single European centre experience

“…However, a tumour location adjacent to the gallbladder or other viscera precludes a percutaneous approach because of the potential thermal injury and the consequent risk of perforation . These arguments, together with the high incidence of needle track seeding associated with subcapsular lesions reported by our group compared with others, justified the introduction of laparoscopic RFA in our Centre.…”

“…Relative contraindications to pRFA include tumour location (subcapsular lesions jeopardizing tumoral seeding or proximity to adjacent structures or viscera) or an inability to visualize the tumour by percutaneous ultrasound (US) . In such situations a laparoscopic approach with RFA (LRFA) would appear to be an appealing alternative especially in patients with moderately impaired liver function …”

New scoring system for prediction of microvascular invasion in patients with hepatocellular carcinoma

“…Cabibbo et al . . stressed the possibility of massive bleeding, but did not touch on the concept that HCC is rarely biopsied because of a rich blood supply and the possibility of the tumour spreading within the peritoneal cavity and along the biopsy needle tract.…”

The optimization of needle electrode number and placement for irreversible electroporation of hepatocellular carcinoma

“…These findings suggest that clinicians applying IRE for subcutaneous tumors may find the use of two electrodes more beneficial. This information is also useful, because an increase in the number of electrodes can also lead to increased pain and discomfort for the patient and a greater risk of tumor seeding 38, 39…”