EUS dating with laser ablation against the caudate lobe or left liver tumors: a win-win proposition?

Figures & data

Table 1. Patient characteristics.

Patient	Sex	Age(year)	Primary cancer	Location	Child-Pugh
Case 1	Male	63	HCC	Caudate lobe	B
Case 2	Male	70	Colorectal carcinoma	Caudate lobe	A
Case 3	Male	57	HCC	Caudate lobe	A
Case 4	Male	54	HCC	Left liver	A
Case 5	Female	55	Colorectal carcinoma	Caudate lobe	A
Case 6	Male	56	HCC	Left liver	A
Case 7	Male	67	HCC	Left liver	A
Case 8	Male	63	Colorectal carcinoma	Left liver	A
Case 9	Male	62	HCC	Caudate lobe	A
Case 10	Male	61	HCC	Caudate lobe	A

HCC: Hepatocellular carcinoma.

Figure 1. A 63-year-old man with hepatocellular carcinoma. Preoperative MR and CEUS images showed a mass of 2.2#1.7 cm in size in the caudate lobe (a, b and c) (white arrows). EUS suggested laser fiber inserted into the tumor (d) and then total enhancement of the lesion (e) (white arrows). One year later, substance phase MR image showed that the mass has a complete response (f) (white arrows).

Figure 2. Representative images from a 70-year-old man diagnosed liver metastasis from colon cancer. T1 and T2 MR images revealed a tumor about 2.1#1.7 cm in the caudate lobe (a and b) (white arrows). One laser fiber was ablating the tumor with local enhancement (c) (white arrows). T2 MR image two months obtained after ablation showed complete response in the tumor (d) (white arrows). At the corresponding ultrasounography, it also showed a complete necrosis without any enhanced perfusion in CEUS (e and f) (white arrows).

Figure 3. A 57-year-old man with hepatocellular carcinoma. MR obtained one month before ablation showed the tumor measuring 1.3#1.2 cm in diameter in the caudate lobe (a) (arrowheads). Preoperative EUS indicated a low echo area (b) (arrowheads) and it had increased echogenicity covering the whole mass after ablation (c) (arrowheads). After one month, enhanced MR revealed the lesion complete necrosis (d) (arrowheads).

Figure 4. Representative images from a 54-year-old man diagnosed with hepatocellular carcinoma. Preoperative T2 MR image shows a round tumor about 1.1#1.0 cm in the left liver (a) (arrowheads). After enhanced perfusion of this tumor under CEUS guidance (b) (arrowheads), then a laser fiber ablated the target tumor (c) (arrowheads), and immediately CEUS showed no enhanced perfusion (d) (arrowheads). During six-month follow-up after ablation, T1 (e) and substance phase MR images (f) showed the mass was successfully ablated (arrowheads).

Table 2. The detailed description of EUS-guided laser ablation for tumors.

											CEA (ng/ml)		AFP (ng/mL)		CA19–9 (U/ml)			CA12–5 (U/ml)
Ablation area (cm)Pre-ablation	1st month	3rd month	Last month	Number of fibers (sessions)	Type of needle	Power (W)	Energy (J)	Ablation time (min)	Prognosis	Complication/Outcome	Before	After	Before	After	Before	After	Before		After
MR 3.4#2.7; CEUS 2.2#1.7	MR 3.8#3.2	MR 3.5#2.6	MR 3.1#2.2	1(2)	22G	5W	3600	32(12)	CR	Alive	NA	2.5	3524.7	1671	NA	105.2	NA		NA
MR 2.1#1.9	CEUS 2.5#2.2	MR 2.1#1.7	MR 1.5#0.7	1(3)	22G	5W	11950	58(40)	CR	Alive	9.5		19.1	13.4	NA	6.2	12.7		NA
MR 1.6#1.3; CEUS 1.4#1.0	CT 1.6#1.4		MR 2.7#1.5	1	22G	5W	5200	38(17)	CR	Mild nausea/alive	3.5	2.7	109.2	4.5	NA	20.8	8.5		NA
MR 1.1#1.0	MR 1.4#1.5		MR 0.9#0.7	1	22G	5W	1800	26(6)	CR	Alive	5.3	4	25.7	6.3	7.6	2.5	8.4		11.2
MR 1.2#1.1; CEUS 1.3#1.2	MR 1.6#1.0		MR 1.4#1.2	1	22G	5W	1200	25(4)	CR	Alive	1.6	1.7	2	11.2	20.8	2.5	14.5		15.0
MR 0.9#0.7	MR 1.3#0.8		MR 0.7#0.3	1	22G	5W	1600	26(6)	CR	Alive	1.4	2.6	81.8	6.6	6.2	53.2	15.1		13.2
CEUS 1.3#1.2; MR 1.8#1.5			Disappear in MR	1	22G	5W	1500	25(5)	CR	Alive	2.7	3.3	47.1	<2	<2	32.3	11.2		13.7
US 2.1#1.9; MR 2.2#1.9		MR 2.1#1.5	MR 1.4#1.3	1	22G	5W	1200	26(4)	CR	Alive	5.2	11.9	2.2	2.1	34.2	34	34.2		8.9
CEUS 1.9#1.8	MR 1.8#1.3		Disappear in MR	1(2)	22G	5W	1500	25(5)	CR	Alive	3.3	4.2	31.4	7.8	8.2	47	40.2		16
US 3.0#2.7	MR 4.0#3.1			1(2)	22G	5W	2800	30(10)	CR	Alive	1.4	1.42	7.8	3.9	12.1	4.45	4		8.1

MR: Magnetic resonance;

CT: Computed tomography;

CEUS: Contrast-enhanced ultrasonography;

US: ultrasonography;

CR: Complete response;

AFP: Alpha fetal protein;

CA19–9: Carbohydrate antigen 19–9;

CA12–5: Carbohydrate antigen 12–5;

CEA: Carcinoembryonic antigen;

NA: Not available.

Table 3. Summary of EUS-guided interventional treatment of tumors in 4 published literatures.

Author	Year	Country	Characteristics of patients	Object of study	Treatment method	Needle type	Diameter of ablated area (cm)	Follow-up interval(months)	Complication
Carrara S et al.	2008	Italy	10 liver; 9 spleen	Porcine	EUS-guided RFA	NA	Liver: <5 cm2; spleen: <6 cm2	1–28 days	None
Varadarajulu S et al.	2009	USA	5 liver	Porcine	EUS-guided RFA	19G	2.6 (2.5–2.7)	0–7 days	None
Di Matteo F et al.	2011	Italy	1 HCC in the caudate lobe	Human	EUS-guided LA	22G	2.4#1.7	2	NA
Park JS et al.	2016	Korea	6 branch-duct intraductal papillary mucinous neoplasms	Porcine	EUS-guided RFA+EA	18G	NA	NA	None

HCC: Hepatocellular carcinoma;

EUS: Endoscopic ultrasonography;

RFA: Radiofrequency ablation;

LA: Laser ablation;

EA: Ethanol ablation;

NA: Not available.