Small hepatocellular carcinoma: intratumor ethanol treatment using new needle and guidance systems.

Sheu, Jin‐Chuan; Huang, Guan‐Tarn; Chen, Ding‐Shinn; Sung, Juei‐Low; Yang, Po-Sheng; Wei, Tang; Lai, M Y; Su, Cheng-Tau; Tsang, Yuk‐Ming; Hsu, H C

doi:10.1148/radiology.163.1.3029806

Cited by 91 publications

(28 citation statements)

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“…In 1983, Sugiura et al (46) achieved destruction of a small hepatocellular carcinoma (HCC) with percutaneous injection of ethanol. During the following years encouraging results were obtained in small series of HCC treated with percutaneous ethanol injection therapy (PEIT) (47,48). In 1983, Bown (49) proposed the use of laser as a thermal source for the ablation of liver tumours and during the 1990s the first clinical applications were reported.…”

Section: Minimally Invasive Treatment Options Of Benign Thyroid Nodulesmentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications

Papini

Pacella

Hegedűs

2014

European Journal of Endocrinology

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In patients with thyroid nodules, ultrasound (US) imaging represents an indispensable tool for assessment of the risk of malignancy. Over approximately four decades, innovative technology and successive improvements have facilitated its entry into the routine management and greatly improved its predictive value. When US features cannot reliably rule out thyroid cancer, US guidance allows a correct and safe sampling also of small or deeply located thyroid lesions. Obtained in this way, cytological or microhistological specimens may reliably define the nature of most thyroid nodules, and the information from histochemical or molecular markers shows promise in the classification of the remaining indeterminate cases. While a prompt surgical treatment can be offered in the minority of suspicious or definitely malignant cases, most individuals warrant only a follow-up. However, at initial evaluation, or over the years, a fraction of these benign lesions may grow and/or become symptomatic. Such cases may benefit from US-guided minimally invasive procedures as an alternative to surgery. Image-guided percutaneous treatments most often achieve relief of neck complaints, are inexpensive, and can be performed on an outpatient basis. The risk of major complications, after adequate training, is very low. Importantly, thyroid function is preserved. Currently, percutaneous ethanol injection for cystic lesions and thermal ablation, with laser or radiofrequency, for solid nodules are increasingly used and disseminated beyond the initial core facilities. In centres with expertise and high patient volume, their use should be considered as first-line treatment alternatives to surgery for selected patients with benign enlarging or symptomatic thyroid lesions.

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Section: Minimally Invasive Treatment Options Of Benign Thyroid Nodulesmentioning

confidence: 99%

DIAGNOSIS OF ENDOCRINE DISEASE: Thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications

Papini

Pacella

Hegedűs

2014

European Journal of Endocrinology

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“…Alternatively, some patients were treated by local injection of absolute ethanol under ultrasound guidance, and the results were promising. 36 I again thought of a prospective study to compare surgical resection and local ethanol injection for the treatment of small HCC. Unfortunately, our surgeons were not enthusiastic about undertaking such a study.…”

Section: Early Detection Of Hepatocellular Carcinomamentioning

confidence: 99%

Fighting against viral hepatitis: Lessons from Taiwan

Chen

2011

Hepatology

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Viral hepatitis and its sequelae are important health problems worldwide, including Taiwan. For the last 40 years, Taiwan's scientists and health care providers have worked hard to control these sequelae, and the results have been excellent. The author, Ding-Shinn Chen, had a key role in planning and establishing the control program in Taiwan, and participated in the endeavors from the very beginning. In this perspective, he describes how he became interested in research as a medical student, his encounters with hepatitis B and C, how he and his colleagues started early detection of hepatocellular carcinoma (HCC), how he helped Taiwan's government create and implement the Viral Hepatitis Control Program, and how the effectiveness of the program in the decrease of hepatitis B carriage and HCC was monitored. He also discusses how he pioneered the use of interferon-α plus ribavirin to treat chronic hepatitis C. Hepatitis B viral load as a risk factor for HCC and cirrhosis in hepatitis B surface antigen carriers is reviewed briefly, as is the prevention of sequelae by antiviral therapies. Finally, Dr. Chen discusses unresolved issues that must be addressed and predicts the changes of the patterns of liver disease in Taiwan beyond the mid-21st century, which is in part affected by the fight against viral hepatitis that was initiated in the early 1980s. Conclusion : Dr. Chen's perspective illustrates Taiwan's fight against viral hepatitis over the last 40 years. This experience can be shared by other countries in which the disease is equally prevalent. (Hepatology 2011;)

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“…[34][35][36][37][38][39][40][41] In practice, tumor without capsule (P Å NS). When gross morphology of however, more than two thirds of HCCs diagnosed are still the main tumor was analyzed, the 1-, 2-, 3-, 4-, and 5-year ú3 cm despite early detection programs.…”

Section: % In Patients With 4-to 7-cm Hcc (P å Ns) the 1- 2- 3-mentioning

confidence: 99%

“…With respect to hepatic functional reserve, gery. 5-7 PEI has been thought, in general, not to be indicated the 1-, 2-, 3-, 4-, and 5-year survival rates were 100%, 85%, for these large HCCs ú3 cm 34,[36][37][38][39][40] in which the incidence of 85%, 85%, and 56%, respectively, in 18 patients with Child's intratumor septa formation and capsular invasion of tumor class A; 100%, 100%, 100%, and 0% (1-4 years) in five patients cells is high 42 because it is difficult to inject ethanol throughwith Child's B class; and 60%, 60%, 60%, 60%, and 0% in five out the entire tumor due to the texture of the tumor parenpatients with Child's class C (P Å NS). The 1-, 2-, 3-, 4-, and chyma (solid or necrotic), its resistance to perfusion with eth-5-year cancer-free survival rates for all 28 patients were 70%, anol, or the existence of an intratumor septum, which makes 55%, 27%, 14%, and 0%, respectively.…”

Section: % In Patients With 4-to 7-cm Hcc (P å Ns) the 1- 2- 3-mentioning

confidence: 99%

Treatment of Nodular Hepatocellular Carcinoma Larger Than 3 Cm With Ultrasound–Guided Percutaneous Acetic Acid Injection

et al. 1996

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achieve complete necrosis of HCC. [9][10][11][12][13][14] The long-term survival To assess the efficacy of ultrasound-guided percutanerate for patients with large HCC after TAE is low. [15][16][17] Thus, ous acetic acid (15%, 20%, 30%, 40%, and 50% in concenthere is a strong demand for other effective therapies and for tration) injection for a large nodular hepatocellular carimprovement of TAE results in the treatment of large HCC. cinoma (HCC), percutaneous acetic acid injection wasRecently, we developed a technique called ultrasound (US)-performed using 15% to 50% acetic acid in 28 patients guided percutaneous acetic acid injection (PAI) in which 15% who had one single nodular HCC larger than 3 cm or to 50% acetic acid is used for the treatment of small HCC one main tumor with fewer than two HCCs smaller than and reported that this was effective in the treatment of HCC 3 cm during the past 7.5 years; the main tumor was smaller than 3 cm 19,20 because none of the tumors treated slightly hypervascular in nine patients and was highly with PAI grew again, and the survival rates for patients after hypervascular, showing viable cancer cells despite PAI were better than those for untreated patients. 19-23 transcatheter arterial embolization in 19 patients. DurHerein, we report our experience of US-guided PAI in 28 ing the series of treatment sessions for each patient, the patients with nodular HCC larger than 3 cm that was slightly same concentration of acetic acid was used. Eight (89%) hypervascular (n Å 9) or was highly hypervascular and of nine slightly hypervascular main tumors, 18 (95%) of showed viable cancer cells despite TAE (n Å 19). highly hypervascular main tumors, and all 14 small tumors were treated successfully. No serious complica-PATIENTS AND METHODS tions occurred as a direct sequela to acetic acid injec-Twenty-eight patients with nodular HCC ú3 cm in diameter untion. The 1-, 2-and 3-year recurrence rate from the origiderwent US-guided PAI using concentrations of a 15%, 20%, 30%, nal main tumor was 0%, 20%, and 20%, respectively, in 40%, and 50% acetic acid solution at the Third Department of Medipatients treated with percutaneous acetic acid injection cine, Saitama Medical School, Japan, and two affiliated hospitals in alone and 12%, 24%, and 24% in patients treated with Chiba City, Japan, during the past 7.5 years. Informed consent was percutaneous acetic acid injection after transcatheter obtained from each patient and a family member before treatment. arterial embolization (P Å NS). The 1-, 2-, 3-, 4-, and 5-Percutaneous acetic acid injection was performed on an inpatient year survival rates were 100%, 80%, 80%, 80%, and 0%, basis. Criteria for treatment with PAI included the following: (1) respectively, in the former and 90%, 81%, 81%, 61%, and nodular HCC lesion with a diameter ú3 cm, occurring singly or in association with no more than two small HCCs õ3 cm, (2) US detec-61% in the latter (P Å NS). Percutaneous acetic acid intion of the lesion, and (3) no evidence of portal vein thrombosis or j...

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Small hepatocellular carcinoma: intratumor ethanol treatment using new needle and guidance systems.

Cited by 91 publications

References 0 publications

DIAGNOSIS OF ENDOCRINE DISEASE: Thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications

DIAGNOSIS OF ENDOCRINE DISEASE: Thyroid ultrasound (US) and US-assisted procedures: from the shadows into an array of applications

Fighting against viral hepatitis: Lessons from Taiwan

Treatment of Nodular Hepatocellular Carcinoma Larger Than 3 Cm With Ultrasound–Guided Percutaneous Acetic Acid Injection

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