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Li N, Huber TC. Radiofrequency Ablation for Benign Thyroid Nodules: Radiology In Training. Radiology 2023; 306:54-63. [PMID: 36066365 DOI: 10.1148/radiol.220116] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Two patients, one with benign nonfunctioning nodules and one with functioning thyroid nodules, both of whom underwent radiofrequency ablation, are presented. Preprocedural evaluation, procedural considerations, and follow-up care of thyroid radiofrequency ablation, as well as published evidence on the topic, are discussed.
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Affiliation(s)
- Ningcheng Li
- From the Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239
| | - Timothy C Huber
- From the Dotter Department of Interventional Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239
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Park J, Cha DI, Jeong Y, Park H, Lee J, Kang TW, Lim HK, Park I. Real-Time Internal Steam Pop Detection during Radiofrequency Ablation with a Radiofrequency Ablation Needle Integrated with a Temperature and Pressure Sensor: Preclinical and Clinical Pilot Tests. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2021; 8:e2100725. [PMID: 34351701 PMCID: PMC8498861 DOI: 10.1002/advs.202100725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/29/2021] [Indexed: 06/13/2023]
Abstract
A radiofrequency ablation (RFA) needle integrated with a temperature sensor (T-sensor) and pressure sensor (P-sensor) is designed and utilized for real-time internal steam pop monitoring during RFA. The characteristics of the sensor-integrated RFA needle (sRFA-needle) are investigated quantitatively using a pressure chamber system, and the feasibility and usability of the needle in preclinical and clinical trials is demonstrated. The sharp changes in the temperature and normalized pressure sensor signals induced by the abrupt release of hot and high-pressure steam can be clearly monitored during the steam pop phenomena. The basic mechanism of the preliminary steam pop is hypothesized and verified using in situ ultrasound imaging data and computational analysis data of the RFA procedure. Moreover, the usability of the system in clinical trials is investigated, and the steam pop phenomena during the RFA procedure are detected using T-sensor and P-sensor. The results confirm that the sensor integration on the medical needle can provide critical data for safer and more effective medical practices.
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Affiliation(s)
- Jaeho Park
- Department of Mechanical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141South Korea
- Present address:
Department of Chemical EngineeringStanford UniversityStanfordCA94305United States
| | - Dong Ik Cha
- Radiology and Center for Imaging ScienceSamsung Medical CenterSungkyunkwan University School of MedicineSeoul06351South Korea
| | - Yongrok Jeong
- Department of Mechanical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141South Korea
| | - Hayan Park
- Radiology and Center for Imaging ScienceSamsung Medical CenterSungkyunkwan University School of MedicineSeoul06351South Korea
| | - Jinwoo Lee
- RF Medical Co. Ltd.Seoul08511South Korea
| | - Tae Wook Kang
- Radiology and Center for Imaging ScienceSamsung Medical CenterSungkyunkwan University School of MedicineSeoul06351South Korea
| | - Hyo Keun Lim
- Radiology and Center for Imaging ScienceSamsung Medical CenterSungkyunkwan University School of MedicineSeoul06351South Korea
- Department of Health Sciences and TechnologySamsung Advanced Institute for Health Sciences & Technology (SAIHST)Sungkyunkwan University School of MedicineSeoul06355South Korea
| | - Inkyu Park
- Department of Mechanical EngineeringKorea Advanced Institute of Science and Technology (KAIST)Daejeon34141South Korea
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Leung TKW, Ji X, Peng B, Chik GKK, Dai DSHS, Fang G, Zhang T, Cheng X, Kwok KW, Tsang ACO, Leung GKK, Chan PKL. Micro‐electrodes for in situ temperature and bio‐impedance measurement. NANO SELECT 2021. [DOI: 10.1002/nano.202100041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Timothy Ka Wai Leung
- Department of Mechanical Engineering The University of Hong Kong, Pokfulam Hong Kong
| | - Xudong Ji
- Department of Mechanical Engineering The University of Hong Kong, Pokfulam Hong Kong
| | - Boyu Peng
- Department of Mechanical Engineering The University of Hong Kong, Pokfulam Hong Kong
| | - Gary Kwok Ki Chik
- Department of Mechanical Engineering The University of Hong Kong, Pokfulam Hong Kong
- Advanced Biomedical Instrumentation Centre Hong Kong
| | - Derek Shui Hong Siddhartha Dai
- Department of Mechanical Engineering The University of Hong Kong, Pokfulam Hong Kong
- Advanced Biomedical Instrumentation Centre Hong Kong
| | - Ge Fang
- Department of Mechanical Engineering The University of Hong Kong, Pokfulam Hong Kong
| | - Tengfei Zhang
- Department of Materials Science and Engineering Southern University of Science and Technology Shenzhen China
| | - Xing Cheng
- Department of Materials Science and Engineering Southern University of Science and Technology Shenzhen China
| | - Ka Wai Kwok
- Department of Mechanical Engineering The University of Hong Kong, Pokfulam Hong Kong
| | | | | | - Paddy Kwok Leung Chan
- Department of Mechanical Engineering The University of Hong Kong, Pokfulam Hong Kong
- Advanced Biomedical Instrumentation Centre Hong Kong
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Jeong DY, Kang TW, Min JH, Song KD, Lee MW, Rhim H, Lim HK, Sinn DH, Han H. Effect of Perfluorobutane Microbubbles on Radiofrequency Ablation for Hepatocellular Carcinoma: Suppression of Steam Popping and Its Clinical Implication. Korean J Radiol 2020; 21:1077-1086. [PMID: 32691543 PMCID: PMC7371616 DOI: 10.3348/kjr.2019.0910] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/13/2020] [Accepted: 03/16/2020] [Indexed: 01/08/2023] Open
Abstract
Objective To evaluate the effect of perfluorobutane microbubbles (Sonazoid®, GE Healthcare) on steam popping during radiofrequency (RF) ablation for treating hepatocellular carcinoma (HCC), and to assess whether popping affects treatment outcomes. Materials and Methods The institutional review board approved this retrospective study, which included 90 consecutive patients with single HCC, who received percutaneous RF ablation as the first-line treatment. The patients were divided into two groups, based on the presence or absence of the popping phenomenon, which was defined as an audible sound with a simultaneous sudden explosion within the ablation zone as detected via ultrasonography during the procedure. The factors contributing to the popping phenomenon were identified using multivariable logistic regression analysis. Local tumor progression (LTP) and disease-free survival (DFS) were assessed using the Kaplan-Meier method with the log-rank test for performing comparisons between the two groups. Results The overall incidence of the popping phenomenon was 25.8% (24/93). Sonazoid® was used in 1 patient (4.2%) in the popping group (n = 24), while it was used in 15 patients (21.7%) in the non-popping group (n = 69). Multivariable analysis revealed that the use of Sonazoid® was the only significant factor for absence of the popping phenomenon (odds ratio = 0.10, p = 0.048). There were no significant differences in cumulative LTP and DFS between the two groups (p = 0.479 and p = 0.424, respectively). Conclusion The use of Sonazoid® has a suppressive effect on the popping phenomenon during RF ablation in patients with HCC. However, the presence of the popping phenomenon may not affect clinical outcomes.
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Affiliation(s)
- Dong Young Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Keun Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong Hyun Sinn
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heewon Han
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea
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Kim JS, Ko Y, Kwon H, Kim M, Lee JK. Impact of Energy and Access Methods on Extrahepatic Tumor Spreading and the Ablation Zone: An Ex vivo Experiment Using a Subcapsular Tumor Model. Korean J Radiol 2020; 20:580-588. [PMID: 30887740 PMCID: PMC6424823 DOI: 10.3348/kjr.2018.0564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 11/08/2018] [Indexed: 12/19/2022] Open
Affiliation(s)
- Jin Sil Kim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Youngsun Ko
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Hyeyoung Kwon
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Minjeong Kim
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea
| | - Jeong Kyong Lee
- Department of Radiology, College of Medicine, Ewha Womans University, Seoul, Korea.
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Lai ZC, Liang JY, Chen LD, Wang Z, Ruan SM, Xie XY, Lu MD, Hu HT, Wang W. Do hepatocellular carcinomas located in subcapsular space or in proximity to vessels increase the rate of local tumor progression? A meta-analysis. Life Sci 2018; 207:381-385. [DOI: 10.1016/j.lfs.2018.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 06/08/2018] [Accepted: 06/15/2018] [Indexed: 02/07/2023]
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Kim HJ, Rhim H, Lee MW, Jeong WK. Measurement of Intrahepatic Pressure during Microwave Ablation in an Ex Vivo Bovine Liver Model. Gut Liver 2016; 9:784-90. [PMID: 25963083 PMCID: PMC4625709 DOI: 10.5009/gnl14272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Background/Aims We experimented with different ablation methods and two types of microwave antennas to determine whether microwave ablation (MWA) increases intrahepatic pressure and to identify an MWA protocol that avoids increasing intrahepatic pressure. Methods MWA was performed using either a single-step standard ablation or a stepwise increment ablation paired with either a 16-gauge (G) 2-cm antenna or a 14G 4-cm antenna. We compared the maximum pressures and total ablation volumes. Results The mean maximum intrahepatic pressures and ablation volumes were as follows: 16G single-step: 37±33.4 mm Hg and 4.63 cm3; 16G multistep: 31±18.7 mm Hg and 3.75 cm3; 14G single-step: 114±45.4 mm Hg and 15.33 cm3; and 14G multistep: 106±43.8 mm Hg and 10.98 cm3. The intrahepatic pressure rose during MWA, but there were no statistically significant differences between the single and multistep methods when the same gauge antennae were used. The total ablation volume was different only in the 14G groups (p<0.05). Conclusions We demonstrated an increase in intrahepatic pressure during MWA. The multistep method may be used to prevent increased intrahepatic pressure after applying the proper power.
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Affiliation(s)
- Hae Jin Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo Kyoung Jeong
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Min JH, Kim YS, Rhim H, Lee MW, Kang TW, Song KD, Lim HK. Effect of parenchymal uptake of perfluorobutane microbubbles (Sonazoid(®) ) on radiofrequency ablation of the liver: in vivo experimental study. Liver Int 2016; 36:1187-95. [PMID: 26835608 DOI: 10.1111/liv.13081] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 01/22/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS To investigate the differences in mechanical effects and ablation zone between radiofrequency (RF) ablation with and without Sonazoid uptake in an in vivo rabbit liver model. METHODS Our study was approved by the Institutional Animal Care and Use Committee. Twenty-five rabbits were randomly allotted to one of five ablation durations (i.e., 1, 2, 3, 6 and 12 min). For each rabbit, RF ablation was performed twice, before and 10 min after Sonazoid administration (i.e. control group vs. Sonazoid group), using a 1-cm internally cooled electrode (40W) equipped with a parallelly fixed pressure-monitoring device. During ablation, a 'popping' sound was perceived and recorded along with tissue pressure changes and RF ablation parameters. Then, the ablation volume and microscopic changes were compared. RESULTS Popping sounds were more frequently perceived in the control group (21/25 vs. 1/25, P < 0.001). The time to first pressure peak was shorter in the Sonazoid group (22.3 ± 1.1 s vs. 46.3 ± 4.4 s, P < 0.001) with similar pressures (39.8 ± 4.2 mmHg vs. 35.6 ± 4.1 mmHg, P = 0.350). Time to first roll-off and mean power output were significantly less in the Sonazoid group (17.6 ± 1.2 s vs. 71.2 ± 8.2 s, P < 0.001; 9.4 ± 0.3 W vs. 12.8 ± 0.5 W, P < 0.001). Consequently, the Sonazoid group had lower total energy and ablation volumes for all durations. Microscopically, the control group showed larger conflu-ent disruptions, whereas the Sonazoid group showed many smaller disruptions scattered throughout the ablation zones. CONCLUSIONS Radiofrequency ablation after Sonazoid uptake induces a smaller ablation zone than conventional RF ablation. However, it appears to ablate the liver tissue with less mechanical effects.
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Affiliation(s)
- Ji Hye Min
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young-Sun Kim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunchul Rhim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Woo Lee
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Tae Wook Kang
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyoung Doo Song
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo Keun Lim
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.,Department of Health Science and Technology, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University School of Medicine, Seoul, Korea
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Choe J, Kim KW, Kim YI, Chung JW, Huh J, Park J, Ham SJ, Jun MK, Kim PN. Feasibility of a Low-Power Radiofrequency Ablation Protocol to Delay Steam Popping. J Vasc Interv Radiol 2016; 27:268-74. [DOI: 10.1016/j.jvir.2015.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 09/05/2015] [Accepted: 10/09/2015] [Indexed: 12/17/2022] Open
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Ji Hong M, Baek JH, Choi YJ, Lee JH, Lim HK, Shong YK, Hong SJ. Radiofrequency ablation is a thyroid function-preserving treatment for patients with bilateral benign thyroid nodules. J Vasc Interv Radiol 2014; 26:55-61. [PMID: 25446422 DOI: 10.1016/j.jvir.2014.09.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 09/21/2014] [Accepted: 09/21/2014] [Indexed: 01/20/2023] Open
Abstract
PURPOSE To evaluate the efficacy and safety of radiofrequency (RF) ablation for treatment of bilateral thyroid nodules as well as preservation of thyroid function. MATERIALS AND METHODS Between January 2007 and October 2012, 18 patients (16 women and 2 men; mean age, 49.9 y; median age, 44 y; age range, 27-81 y) with bilateral thyroid nodules treated by RF ablation were included in this study. The inclusion criteria included bilateral thyroid nodules, pressure symptoms or cosmetic problems, cytologic confirmation of benignancy without atypical cells, and patient refusal of surgery. We used an RF generator (Cool-tip RF system [Covidien, Boulder, Colorado] or SSP-2000, Taewoong Medical Co, Ltd [Gyeonggi-do, Republic of Korea]) and an 18-gauge internally cooled electrode with 1-cm active tips (Cool-tip [Covidien] or Well-Point RF electrode [Taewoong Medical Co, Ltd]). RF ablation was conducted using the moving shot technique and a trans-isthmic approach. RF ablation was performed in separate sessions for nodules in each lobe. Follow-up ultrasound examinations were performed at 1-6 months, 6-12 months, and during the last month of follow-up. The diameter and volume of the nodule and clinical problems including cosmetic and symptom scores were evaluated before and after the procedure. RESULTS The mean initial nodule size was 4.1 cm ± 1.9, although there was a significant decrease by the time of the last follow-up examination (range, 1-48 mo; mean, 18.1 mo ± 12.8; P < .001, 2.5 cm ± 1.4). The initial nodule volume was 24.4 mL ± 32.2 and was decreased at the last follow-up (6.3 mL ± 19.0, P < .001), with a mean volume reduction of 75.9% ± 19.0. The symptom (P < .001) and cosmetic (P < .001) scores were decreased. Serum hormone levels did not differ significantly before treatment and at the last follow-up (P > .05). CONCLUSIONS RF ablation improves cosmetic problems and symptoms and preserves thyroid function in patients with bilateral thyroid nodules.
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Affiliation(s)
- Min Ji Hong
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul, 138-736, Republic of Korea.
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Hyun Kyung Lim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul, 138-736, Republic of Korea; Department of Radiology, Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - Young Kee Shong
- Department of Endocrinology and Metabolism, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul, 138-736, Republic of Korea
| | - Suck Joon Hong
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, 86 Asanbyeongwon-Gil, Songpa-gu, Seoul, 138-736, Republic of Korea
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Abstract
Hepatocellular carcinoma (HCC) is the second commonest cancer in Taiwan. The national surveillance program can detect HCC in its early stages, and various curative modalities (including surgical resection, orthotopic liver transplantation, and local ablation) are employed for the treatment of small HCC. Local ablation therapies are currently advocated for early-stage HCC that is unresectable because of co-morbidities, the need to preserve liver function, or refusal of resection. Among the various local ablation therapies, the most commonly used modalities include percutaneous ethanol injection and radiofrequency ablation (RFA); percutaneous acetic acid injection and microwave ablation are used less often. RFA is more commonly employed than other local ablative modalities in Taiwan because the technique is highly effective, minimally invasive, and requires fewer sessions. RFA is therefore advocated in Taiwan as the first-line curative therapy for unresectable HCC or even for resectable HCC. However, current RFA procedures are less effective against tumors that are in high-risk or difficult-to-ablate locations, are poorly visualized on ultrasonography (US), or are large. Recent advancements in RFA in Taiwan can resolve these issues by the creation of artificial ascites or pleural effusion, application of real-time virtual US assistance, use of combination therapy before RFA, or use of switching RF controllers with multiple electrodes. This review article provides updates on the clinical outcomes and advances in local ablative modalities (mostly RFA) for HCC in Taiwan.
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Affiliation(s)
- Shi-Ming Lin
- *Division of Hepatology, Liver Research Unit, Department of Gastroenterology and Hepatology, College of Medicine, Chang Gung Memorial Hospital and Chang Gung University 5 Fu-Hsin St., Kwei-Shan, Taoyuan, Taiwan 333 (ROC), Tel.+886 3 3281200 Ext. 8107, E-Mail ;
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Lin SM. Ultrasonography-Guided Radiofrequency Ablation in Hepatocellular Carcinoma: Current Status and Future Perspectives. J Med Ultrasound 2013. [DOI: 10.1016/j.jmu.2013.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Iida H, Aihara T, Ikuta S, Yamanaka N. Effectiveness of impedance monitoring during radiofrequency ablation for predicting popping. World J Gastroenterol 2012; 18:5870-8. [PMID: 23139602 PMCID: PMC3491593 DOI: 10.3748/wjg.v18.i41.5870] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 07/30/2012] [Accepted: 08/04/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To retrospectively evaluate the effectiveness of impedance monitoring for predicting popping during radiofrequency ablation (RFA) using internally cooled electrodes.
METHODS: We reviewed 140 patients (94 males, 46 females; age range 73.0 ± 11.1 year) who underwent RFA between February 2006 and November 2008 with a modified protocol using a limited power delivery rather than a conventional one to avoid popping. All the patients provided their written informed consent, and the study was approved by the institutional review board. Intraprocedural impedances were measured for the study subjects, and the tumors were classified into three types according to the characteristics of their impedance curves: increasing, flat, or decreasing. The tumors were further sorted into seven subtypes (A-G) depending on the curvature of the impedance curve’s increase or decrease. Relative popping rates were determined for the three types and seven subtypes. A chi-square test was performed to estimate statistical significance.
RESULTS: A total of 148 nodules treated by RFA were analyzed. The study samples included 132 nodules of hepatocellular carcinoma, 14 nodules of metastatic liver cancer, and two nodules of intrahepatic cholangiocarcinoma. The numbers of nodules with each impedance curve type were as follows: 37 increasing-type nodules, 43 flat-type nodules, and 68 decreasing-type nodules. Popping occurrence rates were 24.3%, 46.5% and 64.7%, respectively. Flat-type nodules exhibited a significantly higher rate of popping compared to increasing-type nodules (P = 0.039). Decreasing-type nodules exhibited a significantly higher rate of popping compared to increasing-type nodules (P < 0.0001). Notably, nodules that showed a sharp decrease in impedance in the latter ablation period (subtype E) exhibited a significantly higher rate of popping compared to other subtypes.
CONCLUSION: Intraprocedural impedance monitoring can be a useful tool to predict the occurrence of popping during liver tumor RFA performed with internally cooled electrodes.
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Kim JH, Kim PN, Won HJ, Shin YM. Percutaneous radiofrequency ablation using internally cooled wet electrodes for the treatment of hepatocellular carcinoma. AJR Am J Roentgenol 2012; 198:471-476. [PMID: 22268196 DOI: 10.2214/ajr.11.6583] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of our study was to evaluate the efficacy and safety of percutaneous radiofrequency ablation (RFA) using internally cooled wet electrodes in patients with hepatocellular carcinoma (HCC). MATERIALS AND METHODS From March 2008 to October 2010, 122 patients with 129 HCCs (mean size, 2.2 ± 0.6 [SD] cm; range, 0.7-4 cm) were treated with RFA using internally cooled wet electrodes. Primary technical effectiveness, the frequency of major complications, and local tumor progression rates were evaluated. RESULTS Two patients (2%) had major complications (liver abscess, significant pleural effusion) after RFA. When evaluated 1 month after RFA, the primary technical effectiveness rate was 99%. The 1- and 2-year local tumor progression rates were 8% and 12%, respectively. Additionally, there was no difference in effectiveness and complication rates between patients with subcapsular HCC and those with nonsubcapsular HCC. CONCLUSION Percutaneous RFA using internally cooled wet electrodes is safe and provides successful local tumor control in patients with HCC. The safety and effectiveness of RFA using internally cooled wet electrodes are comparable to those reported in the literature using conventional RFA electrodes and are similar for nonsubcapsular and subcapsular tumors.
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Affiliation(s)
- Jin Hyoung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, 388-1, Poongnap-2dong, Songpa-gu, Seoul 138-736, Republic of Korea
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Yoon HM, Kim JH, Shin YM, Won HJ, Kim PN. Percutaneous radiofrequency ablation using internally cooled wet electrodes for treatment of colorectal liver metastases. Clin Radiol 2012; 67:122-127. [PMID: 21906730 DOI: 10.1016/j.crad.2011.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2011] [Revised: 07/27/2011] [Accepted: 08/01/2011] [Indexed: 12/18/2022]
Abstract
AIM To evaluate the efficacy and safety of internally cooled wet (ICW) electrodes, which provide interstitial infusion of saline and intra-electrode cooling simultaneously, in the percutaneous radiofrequency ablation (RFA) of liver metastases from colorectal cancer. MATERIALS AND METHODS From February 2008 to October 2010, 27 patients with 35 hepatic metastatic lesions (mean size 1.99cm; range 0.7-3.8cm) underwent RFA using ICW electrodes. Of these 35 tumours, 32 had diameters ≤3cm, and three had diameters of 3-4cm. Moreover, 18 tumours were non-subcapsular and 17 were subcapsular. RESULTS No patients (0%) had major complications after RFA. During follow-up (median 27 months; range 4.5-36 months), 14 of the 35 treated lesions (40%) showed local tumour progression. The local tumour progression-free survival rates at 1 and 3 years were 73 and 56%, respectively. The local tumour progression-free survival period was significantly longer in patients with tumours ≤2cm than >2cm (p<0.001), but did not differ significantly between patients with non-subcapsular and subcapsular tumours (p=0.454). The overall 1 and 3 year survival rates after RFA were 100 and 77%, respectively. CONCLUSIONS Percutaneous RFA using ICW electrodes is safe and technically feasible for the treatment of liver metastases from colorectal cancer. It provides effective local tumour control with low complication rates and reduced number of needle placements.
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Affiliation(s)
- H M Yoon
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Republic of Korea
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Tiong LU, Field JBF, Maddern GJ. Bimodal electric tissue ablation (BETA) compared with the Cool-Tip RFA system. ANZ J Surg 2012; 82:269-74. [PMID: 22510186 DOI: 10.1111/j.1445-2197.2011.05990.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Bimodal electric tissue ablation (BETA) incorporates the process of electrolysis into radiofrequency ablation (RFA) to increase the size of tissue ablation. This study investigated whether BETA could increase the efficacy of the Cool-Tip RF system (Covidien, Boulder, CO, USA) to produce larger ablations. It also investigated whether applying electrolysis only during the pretreatment phase (called electrochemical treatment (ECT)/RFA group) is as effective as BETA (where electrolysis was used during both the pretreatment and RFA phases). METHODS A Cool-Tip RF system (Covidien) was used to test three types of ablations (RFA, BETA, and ECT/RFA) in a pig liver model. In BETA, 9 V of direct current was provided for 10 min, after which the RF generator was started and both electrical circuits were allowed to run concurrently. In ECT/RFA, however, the direct current circuit was switched off after 10 min of pretreatment and only RFA was performed as described above. Ablation sizes were measured in three dimensions. RESULTS The size of ablations (transverse diameter A and B) produced by BETA and ECT/RFA was significantly larger compared with standard RFA (P < 0/001). BETA also created larger ablations compared with ECT/RFA (P < 0.001). CONCLUSION BETA could improve the efficacy of the Cool-Tip RF system (Covidien) to achieve larger ablations. The increased tissue hydration improved delivery of electrical energy to the tissues and delayed the process of desiccation, thus allowing the ablation process to continue for longer periods of time to produce larger ablations. BETA could be used to treat larger liver tumours more effectively than standard RFA.
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Affiliation(s)
- Leong Ung Tiong
- University of Adelaide Discipline of Surgery, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
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