Efficacy and Safety of Microwave Ablation Assisted by Ultrasound Fusion Imaging for Primary and Secondary Liver Cancers with a Diameter of 3–7 Cm

Figures & data

Table 1 Characteristics and Ablation Parameter Data of 31 Patients with 35 Primary and Secondary Liver Cancers

Characteristic	Value
Age (years)	62.5±11.0^a
Sex (Male/Female)	22/9
Diagnosis (HCC/ICC/MLC)	19/1/11
Metastases (colorectal cancers/gastric cancer/brain solitary fibrous malignant tumor/small intestinal stromal tumor/lung small cell carcinoma)	7/1/1/1/1
Previous treatment (None/TA/TACE/TA+OP/TA+PEI/TA+OP+TACE/TA+OP+PEI)	17/5/1/4/1/2/1
Child-Pugh class (A/B)	30/1
PLT (>100/≤100) (×10^9/L)	28/3
Lesions
Number (Single/Multiple)	18/13
Size (mm)	42(32~70)^b
Size (≤50mm/≥51mm)	25/10
Location (S1/S2/S3/S4/S5/S6/S7/S8)	2/1/1/6/8/5/2/10
Ablation parameters
Number of electrodes/antennas (Single/Two)	23/12
Number of punctures/Number of ablations	4(1~13)/10(4~42)^b
Ultrasound FI (CT/MR-US/3D US-US)	27/8
Supplementary ablation (No/Yes)	16/19
Number of supplementary ablations	2(1~5)^b
Time of ablation procedure (minutes)	32.6±17.2^a
Auxiliary means (None/Artificial pleural fluid/Artificial ascites/Single lung ventilation/Bile duct cooling/Laparoscope)	10/2/9/15/1/1

Notes:^aData are means ± standard deviations (ranges).^bData are median values (range).

Abbreviations: HCC, hepatocellular carcinomas; ICC, intrahepatic cholangiocarcinoma; MLC, metastatic liver cancers; TA, thermal ablation; TACE, transarterial chemoembolization; PEI, Percutaneous ethanol injection; OP, operation; PLT, platelet; FI, fusion imaging; CT, computed tomography; MR, magnetic resonance; 3D, three-dimensional; US, ultrasound.

Figure 1 A 50-year-old man had a 5.1 cm MLC lesion pathologically confirmed as gastric cancer. (A) CEUS showed a large-sized MLC nodule (51 × 47 mm) in segment VI/VII. (B) after extraction and storage of the 3D ultrasound volume image in the volume navigation system, the target MLC nodule (yellow) and its 5mm-AM (red) were outlined on 3DUS-US FI. (C and D) The target MLC nodules were ablated with two electrodes based on 3DUS-US FI guidance, particularly when the nodules became nonobvious after ablation. (E) After 12 ablation cycles, partial perfusion was observed within the nodules on 3DUS-CEUS FI (arrow). (F) Three immediate supplementary ablations were performed under 3DUS-US FI guidance. (G) 3DUS-CEUS FI was evaluated again and the non-perfusion area on the CEUS covered the entire target MLC nodule and its 5mm-AM. (H) One month later, contrast-enhanced CT confirmed the results of complete ablation.

Figure 2 A 54-year-old woman had a 4.4 cm HCC lesion. (A) Contrast-enhanced MR showed a medium-sized HCC nodule (44 x 30 mm) in segment VI. (B) The DICOM format of contrast-enhanced MR was obtained and imported into the ultrasound FI system, and the target HCC nodules (yellow) and 5mm-AM (red) were outlined on the MR-US FI. (C and D) The target HCC nodules were ablated with a single electrode guided by MR-US FI, especially if the nodules became inconspicuous after ablation. (E) After 16 ablation cycles, MR-CEUS FI showed that the non-perfusion area on the CEUS covered the entire target HCC nodule and its 5mm-AM. (F) One month later, contrast-enhanced MR confirmed complete ablation.

Table 2 Comparison of General Data, Ablation Parameters and Therapeutic Outcomes Between Medium-Sized and Large-Sized Groups

Characteristic	Medium-Sized Group	Large-Sized Group	p-value
Age (years)	62.4±10.1^a	62.8±13.5^a	0.935
Sex (Male/Female)	17/5	5/4	0.385
Diagnosis (HCC/ICC/MLC)	15/0/7	4/1/4	0.192
Previous treatment (None/TA/TACE/TA+OP/TA+PEI/TA+OP+TACE/TA+OP+PEI)	10/5/0/4/1/2/0	7/0/1/0/0/0/1	0.067
Child-Pugh class (A/B)	21/1	9/0	1.000
PLT (>100/≤100) (×10^9/L)	19/3	9/0	0.537
Number of lesions (Single/Multiple)	11/11	7/2	0.237
Size (mm)	38(32–47)^b	61(51–70)^b	<0.001
Ablation parameters
Number of electrodes/antennas (Single/Two)	21/4	2/8	<0.001
Number of punctures/Number of ablations	3(2–5)/8(4–14)^b	7(4–13)/13(7–42)^b	0.002/0.543
Ultrasound FI (CT/MR-US/3DUS-US)	21/4	6/4	0.186
Supplementary ablation (No/Yes)	11/14	5/5	1.000
Number of supplementary ablations	2(1–4)^b	3(1–5)^b	0.325
Time of ablation procedure (minutes)	26.9±9.8^a	46.9±23.4^a	0.026
Efficacy and safety
Technical success rate	100% (25/25)	90.0% (9/10)	0.286
Technique efficacy rate	100% (25/25)	90.0% (9/10)	0.286
LTP rate (2-year)	18.6%	0%	0.328
IDR rate (2-year)	46.1%	38.9%	0.857
OS rate (2-year)	100%	88.2%	0.118
Major complications rate	4.5% (1/22)	11.1% (1/9)	0.503

Notes:^aData are means ± standard deviations (ranges).^bData are median values (range). The values were shown in bold since their differences are statistically significant.

Abbreviations: HCC, hepatocellular carcinomas; ICC, intrahepatic cholangiocarcinoma; MLC, metastatic liver cancers; TA, thermal ablation; TACE, transarterial chemoembolization; PEI, Percutaneous ethanol injection; OP, operation; PLT, platelet; FI, fusion imaging; CT, computed tomography; MR, magnetic resonance; 3D, three-dimensional; US, ultrasound; LTP, local tumor progression; IDR, intrahepatic distant metastasis; OS, overall survival.