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Radiofrequency Ablation of Hepatocellular Carcinoma: Correlation Between Local Tumor Progression After Ablation and Ablative Margin

¹ All authors: Gastroenterology Division of Internal Medicine, Kitasato University East Hospital, 2-1-1 Asamizodai, Sagamihara, Kanagawa 228-8520, Japan.

View larger version (23K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —34-year-old man with hepatocellular carcinoma. Diagram shows thickness of ablative margin around tumor within ablation zone.

View larger version (142K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —34-year-old man with hepatocellular carcinoma. Sonogram shows tumor (arrowhead) before ablation.

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C —34-year-old man with hepatocellular carcinoma. Sonogram shows tumor after ablation.

View larger version (156K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1D —34-year-old man with hepatocellular carcinoma. Transverse contrast-enhanced arterial phase helical CT scan shows tumor (arrowhead) before ablation.

View larger version (144K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1E —34-year-old man with hepatocellular carcinoma. Transverse contrast-enhanced arterial phase helical CT scan shows area in D after ablation. Lesion has been completely ablated. Ablation zone includes ablative margin of more than 5 mm.

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —Curves of local tumor progression, calculated by Kaplan-Meier method, according to presence or absence of contiguous vessels and presence or absence of ablative margin 5 mm. Graph shows log-rank test result that over time presence of contiguous vessels was associated with significantly higher rate of local tumor progression (p = 0.0292).

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —Curves of local tumor progression, calculated by Kaplan-Meier method, according to presence or absence of contiguous vessels and presence or absence of ablative margin 5 mm. Graph shows log-rank test result that over time presence of ablative margin of 5 mm within ablation zone was significantly related to freedom from local recurrence (p = 0.019).

View larger version (8K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Chart shows association between local tumor progression and presence of contiguous vessels and ablative margin of 5 mm within ablation zone in 85 patients with hepatocellular carcinoma (HCC). Number of cases of local tumor progression was high for HCCs with contiguous vessels that did not have ablative margin of 5 mm within ablation zone. Proportion of cases with ablative margin of 5 mm was significantly lower in HCCs with contiguous vessels than in those without contiguous vessels (p = 0.005, chi-square test). Ablative margin was not associated with local tumor progression in HCCs without contiguous vessels.

View larger version (66K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4A —72-year-old man with single outgrowth of hepatocellular carcinoma detected 41 months after ablation with expandable multitined electrode. Diagram shows ablation zone (shading) and local tumor progression (hatching).

View larger version (147K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4B —72-year-old man with single outgrowth of hepatocellular carcinoma detected 41 months after ablation with expandable multitined electrode. Transverse contrast-enhanced arterial phase helical CT scan shows tumor (arrowhead) before ablation.

View larger version (114K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4C —72-year-old man with single outgrowth of hepatocellular carcinoma detected 41 months after ablation with expandable multitined electrode. Transverse contrast-enhanced arterial phase helical CT scan 1 month after ablation.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4D —72-year-old man with single outgrowth of hepatocellular carcinoma detected 41 months after ablation with expandable multitined electrode. Transverse contrast-enhanced arterial phase helical CT scan shows single viable lesion (arrow) that developed 41 months after ablation.

View larger version (50K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5A —50-year-old man with recurrent hepatocellular carcinoma that emerged on other side of vessel. Ablation was done with expandable electrode. Diagram shows ablation zone (shading) and local tumor progression (hatching).

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5B —50-year-old man with recurrent hepatocellular carcinoma that emerged on other side of vessel. Ablation was done with expandable electrode. Transverse contrast-enhanced arterial phase helical CT scan shows lesion (arrowhead) with contiguous vessels before ablation.

View larger version (141K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5C —50-year-old man with recurrent hepatocellular carcinoma that emerged on other side of vessel. Ablation was done with expandable electrode. Transverse contrast-enhanced arterial phase helical CT scan 1 month after ablation shows ablation zone.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5D —50-year-old man with recurrent hepatocellular carcinoma that emerged on other side of vessel. Ablation was done with expandable electrode. Dynamic phase of transverse contrast-enhanced arterial phase helical CT scan 35 months after ablation shows local tumor progression in ablation zone (arrow).

View larger version (136K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5E —50-year-old man with recurrent hepatocellular carcinoma that emerged on other side of vessel. Ablation was done with expandable electrode. Equilibrium phase image corresponding to D shows local tumor progression in ablation zone (arrow).

View larger version (60K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6A —63-year-old man with multiple viable recurrent lesions around ablation zone after treatment of hepatocellular carcinoma with internally cooled electrode. Diagram shows ablation zone (shading) and local tumor progression (hatching).

View larger version (84K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6B —63-year-old man with multiple viable recurrent lesions around ablation zone after treatment of hepatocellular carcinoma with internally cooled electrode. Transverse contrast-enhanced arterial phase helical CT scan shows lesion (arrowhead) before ablation.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6C —63-year-old man with multiple viable recurrent lesions around ablation zone after treatment of hepatocellular carcinoma with internally cooled electrode. Transverse contrast-enhanced arterial phase helical CT scan 1 month after ablation shows ablation zone.

View larger version (80K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6D —63-year-old man with multiple viable recurrent lesions around ablation zone after treatment of hepatocellular carcinoma with internally cooled electrode. Dynamic phase of transverse contrast-enhanced arterial phase helical CT scan 9 months after ablation shows multiple recurrent lesions (arrows). Ablation zone has ablative margin of more than 5 mm. Therefore, multiple viable lesions probably involved intrahepatic metastasis or iatrogenic spread.

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6E —63-year-old man with multiple viable recurrent lesions around ablation zone after treatment of hepatocellular carcinoma with internally cooled electrode. Dynamic phase of transverse contrast-enhanced arterial phase helical CT scan 9 months after ablation shows multiple recurrent lesions (arrows). Ablation zone has ablative margin of more than 5 mm. Therefore, multiple viable lesions probably involved intrahepatic metastasis or iatrogenic spread.

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