Radiofrequency ablation of hepatocellular carcinoma: Treatment success as defined by histologic examination of the explanted liver
Radiofrequency ablation of hepatocellular carcinoma: Treatment success as defined by histologic examination of the explanted liver
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DOI：
10.1148/radiol.2343040153
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发表时间：
2005-03-01
期刊：
影响因子：
19.7
通讯作者：
Busuttil, RW
中科院分区：
文献类型：
--
作者：
Lu, DSK;Yu, NC;Busuttil, RW
目的：通过对移植肝进行组织学检查，对射频消融治疗肝细胞癌的疗效进行回顾性评价。材料和方法：该研究由医学中心机构审查委员会批准，未经知情同意。24名患者(18名男性，6名女性；年龄范围33-71岁；平均年龄56岁)的47个肝癌结节在肝移植前接受了单次或双次射频消融治疗。对移植肝标本苏木精-伊红染色的组织学资料进行回顾，以确定治疗成功与否，定义为治疗部位没有残留或复发的存活癌细胞。在成像过程中观察到的肿瘤大小和大血管(大于或等于3 mm)的存在被测试为治疗成功或失败的潜在预测因素(Fisher精确检验)。在移植前3个月内接受CT或MR检查的患者(21例44个肿瘤)，以组织学资料为参考标准，分析成像结果对残留或复发肿瘤的敏感性和特异性。结果：在射频消融和移植之间平均7.5个月后，47个消融肿瘤中有35个(74%)成功治疗，其中35个肿瘤<3 cm的29个(83%)根据组织学结果成功治疗。治疗成功的结节平均最大直径为2.0 cm，治疗失败的结节平均最大直径为3.1 cm(P=0.014)。15个血管周围病变中有7个(47%)处理成功，而32个非血管周围病变中有28个(88%)处理成功(P<；.01)。图像相关性显示消融后CT和MR成像对肿瘤残留或复发的特异度为100%(33/33)，敏感性为36%(4/11)。结论：组织学证据直接证实射频消融是一种有效的治疗小肿瘤或复发的方法。
PURPOSE: To retrospectively evaluate the effectiveness of radiofrequency (RF) ablation of hepatocellular carcinoma (HCC) by using histologic examination of the explanted liver.MATERIALS AND METHODS: The study was approved by the medical center Institutional Review Board, with waiver of informed consent. Forty-seven HCC nodules in 24 patients (18 men, six women; age range, 33-71 years; mean age, 56 years) were treated with single or double RF ablation sessions prior to liver transplantation. Histologic data from hematoxylin-eosin staining of explanted liver specimens were retrospectively reviewed to determine treatment success, which was defined as the absence of residual or recurrent viable carcinoma cells at treatment site. Tumor size and the presence of large (greater than or equal to3 mm) abutting vessels that were observed during imaging were tested as potential predictors of treatment success or failure (Fisher exact test). In patients who underwent postablation computed tomographic (CT) or magnetic resonance (MR) imaging within 3 months prior to transplantation (21 patients with 44 tumors), imaging results were analyzed for sensitivity and specificity of residual or recurrent tumor by using histologic data as the reference standard.RESULTS: Thirty-five (74%) of 47 ablated tumors, including 29 (83%) of 35 tumors less than 3 cm, were found to be successfully treated on the basis of histologic findings after a mean interval of 7.5 months between RF ablation and transplantation. Nodules that were successfully treated had mean maximal diameter of 2.0 cm, and nodules that were unsuccessfully treated had mean maximal diameter of 3.1 cm (P = .014). Seven (47%) of 15 perivascular lesions were successfully treated whereas 28 (88%) of 32 nonperivascular lesions were successfully treated (P < .01). Imaging correlation showed 100% (33 of 33) specificity and 36% (four of 11) sensitivity of postablation CT and MR imaging for the depiction of residual or recurrent tumor.CONCLUSION: Histologic evidence directly validates RF ablation as an effective treatment of small (