Stereotactic Radiofrequency Ablation of Hepatocellular Carcinoma: a Histopathological Study in Explanted Livers

Abstract

This retrospective study was performed to evaluate the efficacy of three‐dimensional (3D)‐navigated multiprobe radiofrequency ablation (RFA) with intraprocedural image fusion for treatment of hepatocellular carcinoma (HCC) by histopathological examination. From 2009 to 2018, 97 patients (84 men, 13 women; median age, 60 years; range, 1‐71) were transplanted after bridging therapy of 195 HCCs by stereotactic RFA (SRFA). The median interval between the first SRFA and transplantation was 6.8 months (range, 0‐71). The rate of residual vital tissue (RVT) could be assessed in 188 of 195 lesions in 96 of 97 patients by histological examination of the explanted livers using hematoxylin and eosin (H&E) and Tdt‐mediated UTP nick‐end labeling (TUNEL) stains. Histopathological results were compared with the findings of the last computed tomography (CT) imaging before liver transplantation (LT). Median number and size of treated tumors were 1 (range, 1‐8) and 2.5 cm (range, 1‐8). Complete radiological response was achieved in 186 of 188 nodules (98.9%) and 94 of 96 patients (97.9%) and complete pathological response in the explanted liver specimen in 183 of 188 nodules (97.3%) and 91 of 96 patients (94.8%), respectively. In lesions ≥3 cm, complete tumor cell death was achieved in 50 of 52 nodules (96.2%). Residual tumor did not correlate with tumor size (P = 0.5). Conclusion: Multiprobe SRFA with intraprocedural image fusion represents an efficient, minimally invasive therapy for HCC, even with tumor sizes larger than 3 cm, and without the need of a combination with additional treatments. The results seem to justify the additional efforts related to the stereotactic approach.

Minimal ablative margin (MAM) assessment with image fusion: an independent predictor for local tumor progression in hepatocellular carcinoma after stereotactic radiofrequency ablation

“…Overall, our data confirm the enormous efficacy of stereotactic RFA in selected patients with HCC considering the very low LTP rate of only 5.7%. This finding is in line with a recently published study [15], where the efficacy of stereotactic RFA was evaluated by histopathological examination after bridging therapy for liver transplantation. Complete pathological response in the explanted liver specimen was achieved in 183 of 188 nodules (97.3%), and in 50 of 52 nodules > 3 cm (96.2%).…”

“…Technical limitations of the conventional computed tomography (CT)-or US-guided techniques can be overcome by multiple-needle approaches using 3D treatment planning and stereotactic needle placement (termed "stereotactic RFA" or "SRFA") [12][13][14][15][16][17][18][19][20].…”

Stereotactic image‐guided microwave ablation of hepatocellular carcinoma using a computer‐assisted navigation system

“…As previously reported, tumour size was significantly correlated with the development of local tumour progression. This might simply be because of the limitations of tissue destruction by microwave energy and future studies clearly need to show if new multiprobe ablation systems creating overlapping ablation zones will help to overcome this problem . While we were able to see worse local tumour‐progression‐free survival in patients treated for HCCs >3 cm, we could not detect tumour size as a predictor of local tumour progression.…”

“…To optimize guidance of the ablation probe and thus precision in tumour targeting and ablation, advanced stereotactic navigation technology has been introduced, and several navigation systems are now available for image‐guided interventions . First reports on stereotactic percutaneous computed tomography (CT)‐guided ablation of liver tumours have been published, suggesting a safe and accurate treatment . While a few works report oncological benefits when using stereotactic ablation for colorectal liver metastases, no data exists on oncologic outcomes after stereotactic CT‐guided microwave ablation in a large cohort of HCC patients.…”

Thermal ablation—an option in curative treatment of HCC

“…Our group [26] evaluated the effectiveness of stereotactic radiofrequency ablation (SRFA) by histopathological examination of 188 lesions in 96 HCC patients in explanted liver specimens who received SRFA as a bridging therapy before liver transplantation. A complete histopathological response was achieved in 183/188 lesions (97.3%) and 91/96 patients (94.8%).…”