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ABSTRACT: To investigate the application of contrast enhanced ultrasound (CEUS) in planning and guiding for radiofrequency ablation (RFA) for metastatic liver carcinoma (MLC).
One hundred and thirty-five patients with clinically and pathologically diagnosed MLC (from gastrointestinal tumors) were included in the present study, and 104 of them had received CEUS prior to RFA to assess the number, size, shape, infiltration, location and enhancing features of the lesions. Among the 104 patients, 21 (20.1%) were excluded from RFA treatment due to too many lesions or large infiltrative range based on CEUS. The remaining 83 patients with 147 lesions underwent RFA (group A). During the same period, other 31 patients with 102 lesions serving as control group were treated based on findings of conventional ultrasound without contrast (group B). The patients underwent follow-up enhanced CT at the 1st month, and then every 3-6 months after RFA. The tumor was considered as early necrosis if no contrast enhancement was detected in the treated area on the CT scan at the 1st month.
In group A, 72 of 147 MLC lesions (48.9%) showed increased sizes on CEUS. Among them, 48 lesions (66.6%) appeared enlarged in arterial phase, and 24 (33.3%) showed enlarged hypoechoic area in parenchymal phase. CEUS showed total 61 additional lesions in 35 patients (42.1%) (ranged from 8 to 15 mm) compared with conventional ultrasound (US), and 42 (68.8%) of them were visualized in parenchymal phase only. There were total 208 lesions in group A underwent RFA with CEUS planning, and the tumor necrosis rate was 94.2% (196/208). In this group, local recurrence was found in 16 lesions (7.7%) during 3-42 months' following up, and new metastases were seen in 30 cases (36.1%). For group B, the tumor necrosis rate was 86.3% (88/102), local recurrence in 17 lesions (16.7%), and new metastases in 13 cases (41.9%). Tumor early necrosis and recurrence rates were significantly different between the two groups (P=0.018, P=0.016, respectively).
CEUS played an important role in RFA for liver metastases by candidate selecting and therapy planning, which helped to improve the outcome of the treatment.
Chinese Journal of Cancer Research 03/2012; 24(1):44-51. · 0.18 Impact Factor
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ABSTRACT: Most HCC patients with decompensation of liver function lost the chance of surgical and/or interventional treatment. The aim of this study was to evaluate feasibility and outcome of radiofrequency ablation (RFA) in treating hepatocellular carcinoma (HCC) patients with poor liver function (Child-Pugh class C), who are not suitable for surgery or hepatic artery chemo-embolization.
Thirteen HCC patients (the number of tumors was 17) with liver function of Child-Pugh C (scores: 10.2 +/- 0.4) were included in the study. Among the patients, 8 were male and 5 were female with the average age of (61.6 +/- 10.9) years old. The average size of HCC was (3.8 +/- 1.0) cm. Two patients were recurrent HCC and 30.8% of the patients had multiple tumors (2 - 3 tumors). All the patients were treated with RFA.
There were 22 RFA sessions (1 - 4 sessions per patient) in all, average ablations per tumor at first session was 3.1. One week after RFA, the liver enzymes elevated in 9 patients (69.2%), in 7 of them, the liver enzyme returned to pre-RFA level in 1 - 3 months. One month after RFA, the Child-Pugh grading was 10.3 +/- 0.8 (Child-Pugh C), while that of pre-RFA was 10.2 +/- 0.4 (Child-Pugh C), with no significant difference. Computer tomography (CT) one month after RFA showed that the tumor necrosis rate was 88.2% (15/17). Five patients had 2 - 4 repeated RFA due to HCC recurrence. During the follow-up of 2- 69 months in this group, survival rate of one year was 53.8%, two years was 30.8%, and three year was 15.4%. The incidence of RFA-related complications was 13.6% (3/22 sessions), including 1 case of GI hemorrhage and 1 sub-capsular hemorrhage of the liver. One patient with HCC over 5 cm who had fever and liver abscess after RFA, and was dead 2 months later due to liver function failure.
Minimal invasive RFA provides possible treatment modality for HCC patients with poor liver function, who are not candidates for surgical and/or interventional therapy. For large HCC, due to the required extended treatment region, special attention should be paid to the possibility of acute liver failure.
Chinese medical journal 08/2010; 123(15):1967-72. · 0.86 Impact Factor
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ABSTRACT: Aim: To investigate the diagnostic value for the diagnosis of small (1-2 cm) hepatic nodules detected by surveillance ultrasound in patients with cirrhosis using contrast-enhanced ultrasound (CEUS) compared with that of contrast-enhanced helical computed tomography (CECT). Methods: Seventy-two liver cirrhosis patients with 103 small hepatic nodules (1-2 cm) detected by surveillance ultrasound were enrolled in the present study. All patients underwent CEUS with SonoVue as well as CECT. Nodules which appeared by contrast enhancement during the arterial phase and contrast wash-out during the late phase on CEUS or CECT were diagnosed as malignant (hepatocellular carcinoma [HCC]). Histopathology obtained from biopsy or surgery served as the gold standard. Results: According to the above diagnostic criteria, the sensitivity (i.e. rate of correct diagnosis of HCC) was 91.1% (51/56 HCC) for CEUS and the specificity (i.e. the rate of correct exclusion of HCC) was 87.2% (41/47 regenerative nodules [RN]).Therefore, the diagnostic accuracy of CEUS was 89.3% (92/103 all nodules). Using the same diagnostic criteria, the sensitivity, specificity and accuracy of CECT were 80.4% (45/56 HCC), 97.9% (46/47 RN), and 88.4% (91/103 all nodules). Overall, there was no significant difference between CEUS and CECT in the diagnostic confidence of small hepatic nodules. Eighty-six nodules (45 HCC and 41 RN) were correctly diagnosed by both modalities and six (five HCC and one RN) were misdiagnosed by both. Conclusion: The ability of CEUS in the characterization of small nodules (1-2 cm) detected by surveillance US in patients with liver cirrhosis is similar to that of CECT.
Hepatology Research 04/2008; 38(3):281-90. · 2.20 Impact Factor
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ABSTRACT: The purpose of this study was to evaluate the use of contrast-enhanced ultrasonography (CEUS) in selecting patients with hepatocellular carcinoma (HCC) for radio frequency ablation (RFA).
One hundred seventy-nine patients with HCC were divided into 2 groups before receiving RFA: a CEUS group and a control group. The patients were concatenated and alternately apportioned into these 2 groups. In the CEUS group, 92 patients underwent pre-RFA CEUS using the contrast agent sulfur hexafluoride and enhanced computed tomography or magnetic resonance imaging before RFA for selecting suitable cases for RFA, and in the control group, conventional ultrasonography and enhanced computed tomography or magnetic resonance imaging were performed in 87 patients for selecting patients.
In the CEUS group, 9 patients (9.8%) were excluded for RFA therapy by CEUS. The other 83 patients (90.2%), with a total of 114 lesions, were treated by RFA. In the control group, 5 patients (5.7%) were excluded for RFA. The other 82 patients (94.3%), with a total of 107 lesions, were treated by RFA. During the follow-up period of 18 to 50 months, the primary technique effectiveness rates in the CEUS and control groups were 94.7% and 87.9%, respectively (P = .1182). The local tumor progression rate, the new HCC rate, and the repeated RFA rate of the CEUS group were significantly lower than those of the control group (P = .033, .004, and .001, respectively).
Pre-RFA CEUS provides important information for selecting suitable patients for RFA. The use of CEUS in selecting patients with HCC can decrease post-RFA local tumor progression and improve the efficacy of RFA therapy.
Journal of ultrasound in medicine: official journal of the American Institute of Ultrasound in Medicine 09/2007; 26(8):1055-63. · 1.25 Impact Factor
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ABSTRACT: To evaluate whether contrast-enhanced ultrasound (CEUS) with SonoVue could differentiate malignant focal liver lesions (FLLs) from benign lesions and provide lesion type diagnoses.
Four hundred fifty-six patients with 554 FLLs were examined by CEUS with SonoVue using low mechanical index, nonlinear imaging techniques. Each lesion was characterized by 2 independent off-site readers as malignant or benign and given specific lesion type diagnosis, if possible, both at baseline ultrasound (US) and after SonoVue administration (CEUS). The final diagnosis was achieved by histopathology obtained from biopsy or surgical specimens, or by typical manifestation on contrast-enhanced CT or MRI.
The diagnostic accuracies of the 2 readers were 41.9% and 35.2% for baseline US, which improved significantly to 87.2% and 87.9% for CEUS (P < 0.05). Interreader agreement also increased with CEUS compared with baseline US (ê value changed from 0.49 to 0.77). The accuracy for lesion type diagnosis was 38.4% and 32.5% for baseline US, which increased to 77.6% and 78.0% for CEUS (P < 0.05).
CEUS with SonoVue improves differentiation between malignant and benign FLLs, and also provides improved lesion type (differential) diagnosis.
Investigative Radiology 09/2007; 42(8):596-603. · 4.59 Impact Factor
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ABSTRACT: Comprehensive studies are scarce with regard to the quality of life (QOL) of hepatocellular carcinoma (HCC) patients after transcatheter arterial chemoembolization (TACE) and/or radiofrequency ablation (RFA) treatment. The purpose of this study was to examine the impact of TACE alone and that of the TACE followed by RFA (TACE-RFA) on QOL in HCC patients.
QOL was measured using the Functional Assessment of Cancer Therapy-General (FACT-G) (Version 4.0) questionnaire, translated into Chinese, as a measure of QOL among Chinese HCC patients. Prospectively, 83 patients in both TACE group (n = 40) and TACE-RFA group (n = 43) completed the questionnaire at baseline and 3 months after treatment, respectively.
The TACE-RFA group resulted in a significantly higher total QOL score, socio-family well-being score, and functional well-being score than that of TACE group, 3 months after respective treatment. Liver function, tumor recurrence and complication, age, income were the most important factors affecting the QOL of HCC patients after treatment. The logistic regression analyses showed that Child-Pugh Class and tumor recurrence after treatment were independent predictors of post-treatment QOL scores of HCC patients.
The overall QOL of HCC patients in TACE-RFA group was maintained at a relatively higher level than that of TACE group. TACE followed by RFA appeared to be more favorable than TACE alone with respect to QOL.
Quality of Life Research 05/2007; 16(3):389-97. · 2.30 Impact Factor
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ABSTRACT: The objective of our study was to evaluate the clinical utility of performing contrast-enhanced sonography before percutaneous biopsy of focal liver lesions.
One hundred eighty-six patients with focal liver lesions detected on either sonography or contrast-enhanced CT were randomly divided into two groups: a group who underwent contrast-enhanced sonography and another who underwent unenhanced sonography. The contrast-enhanced sonography group (79 patients, 129 lesions) underwent SonoVue-enhanced sonography before biopsy, and the unenhanced sonography group (107 patients, 143 lesions) did not undergo contrast-enhanced sonography before biopsy. Conventional sonography was used in all patients to guide the biopsy procedures. The pathologic diagnosis was considered definitive and final if the biopsy result was malignant. If the initial biopsy result was benign or negative for malignancy, then the result was either confirmed or denied on the basis of contrast-enhanced CT, MRI, angiography, serum alpha-fetoprotein level, or clinical follow-up over a period of 6 months. In some patients with suspected malignancy, biopsy was repeated when considered necessary during the follow-up. The diagnostic accuracy of the initial biopsy was defined as the percentage of the total number of lesions that were correctly diagnosed at the initial biopsy. The difference in diagnostic accuracy between the two groups was analyzed to evaluate the value of performing contrast-enhanced sonography before biopsy.
Of the 129 lesions in the contrast-enhanced sonography group, 28 (21.7%) were benign and 101 (78.3%) were malignant. Of the 143 lesions in the unenhanced sonography group, 36 (25.2%) were benign and 107 (74.8%) were malignant. There was no significant difference in the distribution of malignant and benign lesions in these two groups (p > 0.05). There was no statistically significant difference in the distribution of lesions by size between the contrast-enhanced and unenhanced sonography groups (chi(2) = 0.619, p > 0.05). The diagnostic accuracy of the initial biopsy was significantly higher in the contrast-enhanced sonography group than in the unenhanced sonography group (95.3% vs 87.4%, respectively; p < 0.05). The diagnostic accuracy of the initial biopsy for malignant lesions < or = 2.0 cm was also significantly higher in the contrast-enhanced sonography group than in the unenhanced sonography group (97.1% vs 78.8%, respectively; p < 0.05). No major complications occurred in our study except one case of pneumothorax in the unenhanced sonography group.
Contrast-enhanced sonography before percutaneous focal liver lesion biopsy improved the diagnostic accuracy of the procedure by providing important intralesional information for differentiating viable, denaturalized, or necrotic tissue; consequently, by providing more accurate information about the site of biopsy even in lesions < or = 2.0 cm, contrast-enhanced sonography before biopsy reduced the number of puncture attempts.
American Journal of Roentgenology 09/2006; 187(3):752-61. · 2.78 Impact Factor
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ABSTRACT: This study aimed to investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) of small hepatocellular carcinomas (HCC) (</=3cm) in patient with cirrhosis.
Fifty-seven cases with 64 small HCC tumors (</=3cm) were analyzed in this study. In these cases, all patients had liver cirrhosis and surgical or biopsy histopathological diagnosis. Diagnosis of baseline ultrasound (US) and CEUS of each lesion was made separately using a 5-point scoring system based on the US and CEUS characteristics of the lesions and was compared with histopathological results.
All of the 47 moderately to poorly differentiated (MD-PD) HCC presented the "fast-in and fast-out" (FIFO) pattern with fast enhancement within 25s and then a quick wash-out within 90s after contrast injection. Ten of 17 well-differentiated (WD) HCC (58.8%) had "fast-in and slow-out" (FISO) pattern which washed out after 90s and 1 WD HCC had "fast-in and no-out" (FINO) pattern which did not wash out till 360s. Three well differentiated clear cell carcinomas smaller than 1.5cm showed "slow-in and slow-out" (SISO) pattern which enhanced after 25s and washed out after 90s. On baseline US, only 36 lesions (56.3%) were diagnosed as definitely or possibly malignant lesions. After CEUS, 50 lesions (78.1%) with "FIFO" pattern were diagnosed as definitely malignant, while 15.6% (10 lesions) with "FISO" pattern as possibly malignant, only 4 lesions (6.3%) with "FINO" or "SISO" pattern could not be diagnosed by CEUS.
The typical enhancement patterns of "FIFO" or "FISO" of small HCC could improve the diagnostic ability of ultrasound in cirrhotic liver. Small HCC also had atypical enhancement patterns including "FINO" and "SISO". It shows that CEUS could be a useful imaging modality in small HCC diagnosis.
Hepatology Research 08/2006; 35(4):281-8. · 2.20 Impact Factor
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ABSTRACT: Our purpose was to investigate the correlation of contrast-enhanced sonographic patterns with the histopathology of primary malignancies of the liver.
Of the 318 contrast-enhanced sonographic examinations performed between April and September 2004, 95 patients with 117 lesions confirmed by surgery or biopsy pathology were reviewed in this study. We analyzed the enhancement time and patterns according to the types and degrees of pathologic differentiation.
All 65 moderately to poorly differentiated hepatocellular carcinomas (HCCs) enhanced in the arterial phase, and 96.9% (63 lesions) of them quickly washed out in the portal venous phase. All 32 well-differentiated HCCs enhanced in the arterial phase, and 50.0% (16 lesions) washed out slowly during the late phase. The washout time of the two differentiated types was significantly different (p < 0.05). Seventy-five percent of the clear cell carcinomas (12/16) enhanced in the arterial phase, 25% (4/16) did not enhance until the portal venous phase, and 31.3% (5/16) of the clear cell carcinomas washed out slowly during the late phase. The enhancement and washout times of clear cell carcinomas were significantly different than those of moderately to poorly differentiated HCCs (p < 0.05). All four intrahepatic cholangiocarcinomas presented the same patterns as moderately to poorly differentiated HCCs: enhanced in the arterial phase and quickly washed out in the portal venous phase. Among the 72 lesions enhanced homogeneously, 46 lesions (63.9%) were smaller than 3 cm. Thirty-seven lesions (82.2%) of the 45 lesions that enhanced heterogeneously were larger than 3 cm (including the four cholangiocarcinomas). Larger lesions were mainly less differentiated. There were significant differences in tumor sizes in regard to cellular differentiations and types.
Our study showed that the enhancement manifestations of primary malignancies of the liver are related to pathologic types and grades. Contrast-enhanced sonograms may provide the histopathologic information for malignant tumors of the liver.
American Journal of Roentgenology 06/2006; 186(6):1512-9. · 2.78 Impact Factor
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ABSTRACT: The purposes of this study were to investigate a treatment strategy to increase liver tumor necrosis and minimize complications with ultrasound-guided percutaneous radiofrequency (RF) ablation and to evaluate its therapeutic efficacy.
A total of 332 patients with 503 liver malignancies underwent RF ablation according to a mathematical protocol with adjunctive measures. In the 332 patients, 205 had 308 hepatocellular carcinomas (HCCs) with a mean largest diameter of 4.1 cm and 127 had 195 metastatic liver carcinomas (MLCs) with a mean largest diameter of 3.9 cm. In patients with HCC, 60 (29.3%) had stage I/II disease and 145 (70.7%) had stage III/IV disease. Depending on tumor size, shape, and location, a defined treatment strategy was adopted that consisted of a mathematical protocol, an individualized protocol, and adjunctive measures. The mathematical protocol was followed for tumors larger than 3.5 cm. The individualized protocol was used for tumors located adjacent to the diaphragm, gastrointestinal tract, or gallbladder. Some adjunctive measures such as supplementary fine needle localization, local saline solution injection, and feeding vessel ablation were used to deal with different features of these liver tumors. Patients were followed regularly to assess treatment efficiency, and the tumor was considered to have early complete necrosis if no viability was found on enhanced computed tomography 1 month after RF ablation.
In this series, the early necrosis rates were 95.8% for HCC (295 of 308 tumors), 94.9% for MLC (185 of 195 tumors), 91.3% for tumors larger than 3.5 cm (189 of 207 tumors), 90.7% for tumors near the gastrointestinal tract (49 of 54 tumors), 91.5% for tumors near the diaphragm (86 of 94 tumors), and 90.6% for tumors near the gallbladder (48 of 53 tumors). The local recurrence rates were 10.7% for HCC (33 of 308 tumors) and 14.9% for MLC (29 of 195 tumors). The 1-, 2-, and 3-year overall survival rates were 89.6%, 69.4%, and 59.6%, respectively, for HCC and 80.3%, 52.8%, and 30.9%, respectively, for MLC. The 1-, 2-, and 3-year survival rates in 60 patients with stage I/II HCC were 93.7%, 87.1%, and 76.2%, respectively. The incidence of major complications was 1.4% (eight of 574 sessions), which included of three hemorrhages, four injuries to adjacent structures, and one case of needle tract seeding.
In RF ablation of hepatic tumors, application of a proper protocol and adjunctive measures play important roles in improving tumor necrosis rate and minimizing potential complications.
Journal of Vascular and Interventional Radiology 05/2006; 17(4):671-83. · 2.08 Impact Factor
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ABSTRACT: Our objective was to assess the efficacy and safety of radiofrequency ablation of recurrent hepatocellular carcinoma (HCC) after hepatectomy and to compare the effects on early- and late-phase recurrence.
We studied 41 patients with 76 recurrent HCC tumors (diameter range, 2.0-6.6 cm; mean, 3.8 +/- 1.3 [SD] cm) after hepatectomy who underwent sonography-guided percutaneous radiofrequency ablation in our hospital (recurrent-HCC group). The interval between surgery and recurrence ranged from 1 to 96 months (mean, 24.5 months). These patients were divided into an early-recurrence group (20 patients with 41 recurrent HCC tumors) and a late-recurrence group (21 patients with 35 recurrent HCC tumors). Early recurrence was defined as that occurring within 1 year after surgery, and late recurrence was defined as that occurring after 1 year. Another 116 patients with 172 primary HCC tumors (diameter range, 1.2-7.0 cm; mean, 3.9 +/- 1.1 cm) treated by radiofrequency ablation were regarded as a control group. No other therapies were given before radiofrequency ablation in any group. Regular follow-up with enhanced CT was performed to evaluate the treatment results. Ablation was considered successful if no contrast enhancement was detected in the treated area on 1-month CT scans. Indexes including ablation success rate, local recurrence rate, distant recurrence rate, and survival were obtained for analysis and comparison.
The ablation success rate, local recurrence rate, distant recurrence rate, and mean overall survival time of the recurrent-HCC group were 93.4% (71/76 tumors), 9.2% (7/76 tumors), 36.6% (15/41 patients), and 30.9 +/- 3.7 months, respectively. The incidence of distant recurrence in the early-recurrence group was significantly higher than that in the late-recurrence group (55.0% vs 19.0%, p = 0.017). The early-recurrence group had a shorter overall survival than did the late-recurrence group (mean overall survival, 16.4 +/- 2.4 vs 42.9 +/- 4.4 months, p < 0.001) or the control group (16.4 +/- 2.4 vs 45.9 +/- 2.5 months, p < 0.001). The survival time of the late-recurrence group was similar to that of the control group (42.9 +/- 4.4 vs 45.9 +/- 2.5 months, p > 0.05). Serious hemorrhage after radiofrequency ablation occurred in one patient in the late-recurrence group and was controlled with conservative treatment.
Radiofrequency ablation is generally effective and safe in treating recurrent HCC after hepatectomy and is more effective in late recurrence than in early recurrence.
American Journal of Roentgenology 05/2006; 186(5 Suppl):S275-83. · 2.78 Impact Factor
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ABSTRACT: To analyze the ultrasonographic features of axillary lymph node metastasis in breast cancer patients, and to evaluate the accuracy of these features by Receiver Operating Characteristic (ROC) curve.
Ultrasonography was carried out in 113 patients (mean age 56.5 yr, range 29 - 77 yr). The ultrasonographic features of the primary tumor and the axillary lymph node were observed. Univariate analysis was performed by Chi-squared test and Fisher exact test, and multivariate analysis to determine independent significant individual variables by multiple logistic regression analysis. ROC curve analysis was done to determine the sensitivity and specificity of individual and combined ultrasonographic features in distinguishing metastatic lymph node from the normal one.
The primary tumor size, abundance of blood supply in the primary tumor, longitudinal-transverse diameter ratio, cortex-hilum thickness ratio (on the longitudinal section), abnormal cortex thickness, distribution of intra-nodal vascularity of axillary lymph nodes were found to be statistically significant factors by univariate analysis. The primary tumor size, longitudinal-transverse ratio and cortex-hilum thickness ratio of lymph node were proved to be significant independent predictors of axillary lymph node metastasis by logistic regression analysis. Through ROC analysis, the combination of these independent ultrasonographic feature predictors was found to contribute significantly in differentiating metastatic lymph node from the normal with a sensitivity of 88.6% and specificity of 84.5%.
Axillary ultrasonography is helpful in staging the axillary lymph node in breast cancer patient. The primary tumor size, longitudinal-transverse diameter ratio and cortex-hilum thickness ratio of lymph node are the main features to determine whether metastatic involvement is present or not.
Zhonghua zhong liu za zhi [Chinese journal of oncology] 02/2006; 28(1):65-9.
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ABSTRACT: To evaluate the clinical utility of contrast-enhanced ultrasound (CEUS) in percutaneous liver biopsy of focal liver lesions.
Two hundred and eleven patients with unidentified space occupying lesions in liver, 112 males and 74 females, aged 52 (16-78), were randomly divided into 2 groups: CEUS group in which 96 cases with 149 lesions underwent liver biopsy with 21-18 gauge needles directed by real time grey CEUS, and routine ultrasound (US) group in which 115 patients with 153 lesions underwent biopsy guided by conventional ultrasonography. There was no significant difference in the size of lesions between these 2 groups. There were 75 minute malignant lesions with the size of < or = 2.0 cm (24.8%) in 67 patients, 12.9% in the CEUS group and 11.9% in the US group. Obtainment of adequate specimen for pathological examination meant successful biopsy. Definite diagnosis was made by the combination of the results of pathological examination, CEUS, CT, MRI, angiography, serum alpha-fetoprotein, and 3 to 6-month follow-up.
The proportion of no more than 2 puncture attempts in the CEUS group was 33/19, significantly higher than that in the US group (8/153, P = 0.0007). The biopsy success rate of the CEUS group was 98.7%, significantly higher than that of the US group (91.5%, P = 0.0096). The accurate diagnosis rate of the CEUS group was 96.0%, significantly higher than that of the US group (87.6%, P = 0.0165). The accurate diagnosis rate of malignant lesions with the size of < or = 2.0 cm in the CEUS group was 97.4%, significantly higher than that in the US group (80.6%, P = 0.0473). Among the 112 confirmed malignant lesions in the US group 15 had been diagnosed as benign by pathological examination of the biopsy specimens with a false negative rate of 13.4%. The relevant patients underwent CEUS-guided biopsy again and 14 of the 15 lesions were confirmed as malignant finally and the size of 6 of the 14 lesions was < or = 2.0 cm. Except for one case of pneumothorax in the US group no major complication occurred.
Biopsy guided by CEUS is more accurate in location and diagnosis of malignant lesions and minute tumors in the liver, thus increasing the success rate of biopsy and the confirmed diagnosis rate of malignant lesions.
Zhonghua yi xue za zhi 02/2006; 86(2):116-20.
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ABSTRACT: To evaluate the clinical value of contrast-enhanced ultrasound (CEUS) in selection of the patients with hepatocellular carcinoma (HCC) indicated to radiofrequency ablation (RFA).
164 patients with HCC, 121 males and 43 females, aged 52.4 (38-72), who asked for RFA were randomly divided into 2 groups: 81 patients undergoing CEUS before RFA (CEUS Group), and 83 patients not undergoing CEUS before RFA (Control Group). There were not significant differences in the TNM staging, liver function Child-Pugh classing, and average tumor size between the 2 groups. Follow-up by conventional ultrasonography, enhanced CT and/or enhanced ultrasonography was conducted for 6-36 months.
Nine of the 81 patients in CEUS Group (11.8%) were determined by CEUS as unsuitable for RFA; 5 of the 9 patients had more than 5 lesions, 2 of the 9 patients had lesions > 8 cm in diameter, and the tumor had invaded 2 large vessels or intestine in 2 of the 9 patients. The other 72 patients in CEUS Group, with 101 lesions, underwent RFA after CEUS. CEUS discovered 12 lesions < or = 1.7 cm that had not been discovered by conventional ultrasonography and CT in 8 patients, 3 of which were patients with cirrhosis undergoing follow-up, and 2 of which were HCC patients undergoing follow-up after treatment. Of these 8 patients, 3 had 7 newly discovered satellite lesions around the main lesions. The successful rates of CEUS Group and Control Group were 95.0% and 89.6% respectively (P > 0.05). The distant recurrence rate of Control Group was 22.9%, significantly higher than that of CEUS Group (9.7%, P < 0.05).
Helping find minute tumors, CEUS is useful in selecting HCC patients suitable for RFA, thus decreasing the intrahepatic recurrence after RFA.
Zhonghua yi xue za zhi 01/2006; 85(49):3491-4.
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ABSTRACT: To investigate the diagnostic value of contrast-enhanced ultrasound (CEUS) enhancement patterns of hepatocellular carcinoma (HCC) smaller than 2 cm.
From 392 cases with focal liver lesions undergoing CEUS with SonoVue and Contrast Tuned Imaging (CnTI) technique, thirty six cirrhotic patients with thirty eight HCCs with histopathological diagnosis were retrospectively analyzed in this study. Surgery or needle biopsy was performed within fifteen days after CEUS. Twenty two tumors were finally diagnosed as moderately differentiated HCC, twelve as well differentiated HCC, and four as clear cell carcinomas using Edmondson Grade system. The enhancement patterns of different histopathological HCCs were analyzed.
Before CEUS, only 16 lesions (42.1%) were diagnosed as malignant or possibly malignant. After CEUS, 38 HCCs were enhanced in different degrees following contrast administration,of which, all the 22 moderately differentiated HCCs presented typical "fast-in and fast-out" pattern with fast enhancement in arterial phase and then a quick wash-out in the parenchymal phase. Nine (75.0%) of the 12 well differentiated HCCs presented "fast-in and slow-out" pattern. One of the 4 clear cell carcinomas presented "fast-in and fast-out", one presented "fast-in and slow-out" and the other 2 presented "slightly slow-in and slow-out" pattern. According to the enhancement patterns, 76.3% (29 tumors) were considered as malignant, while 18.4% (7 tumors) as possibly malignant, only 5.3% (2 tumors smaller than 1.5 cm) could not be diagnosed by CEUS.
The identification of different enhancement patterns of various histological types of small HCCs could improve the diagnostic ability of ultrasound in cirrhotic liver. CEUS might be also helpful in detecting small HCCs. Thus CEUS could be a complementary method of enhanced CT and other imaging methods in early diagnosis of HCCs.
Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences 11/2005; 37(5):458-62.
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ABSTRACT: To investigate the treatment efficacy of radiofrequency ablation (RFA) of hepatic malignant tumor and the relevant complications.
A total of 338 patients with 763 hepatic tumors underwent ultrasound-guided RFA (565 procedures). There were 204 cases of hepatic cellular carcinoma (HCC) with 430 tumors, the mean largest diameter was 4.0 cm. Of them, 48 patients (23.5%) were in stages I-II (UICC Systems) and 156 (76.5%) in stages III-IV There were 134 cases of metastatic liver carcinoma (MLC), with 333 metastases in the liver, the mean diameter was 4.1 cm, the liver metastases of 96 patients (71.6%) came from gastrointestinal tract. Ninety-three percent of the 338 patients were treated using the relatively standard protocol. Crucial attention must be paid to monitor the abnormal changes in ultrasound images as well as the vital signs of the patients to find the possible hemorrhage and peripheral structures injury in time. The tumors were considered as ablated completely, if no viability was found on enhanced CT within 24 h or at 1 mo after RFA. These patients were followed up for 3-57 mo.
The ablation success rate was 93.3% (401/430 tumors) for HCC and was 96.7% (322/333 tumors) for MLC. The local recurrence rate for HCC and MLC was 7.9% (34/430 tumors) and 10.5% (35/333 tumors), respectively. A total of 137 patients (40.5%) underwent 2-11 times of repeated ablations because of tumor recurrence or metastasis. The 1st, 2nd, and 3rd year survival rate was 84.6%, 66.6%, and 63.1%, respectively; the survival rate from 48 patients of I-II stage HCC was 93.7%, 80.4%, and 80.4%, respectively. The major complication rate in this study was 2.5% (14 of 565 procedures), which consisted of 5 hemorrhages, 1 colon perforation, 5 injuries of adjacent structures, 2 bile leakages, and 1 skin burn.
RFA, as a minimally invasive local treatment, has become an effective and relatively safe alternative for the patients of hepatic malignant tumor, even of advanced liver tumor, tumor recurrence, and liver metastases. Knowledge about possible complications and their control may increase the treatment efficacy and help to promote the use of RFA technique.
World Journal of Gastroenterology 11/2005; 11(40):6395-401. · 2.47 Impact Factor
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ABSTRACT: To investigate the prognostic factors affecting outcome in Radiofrequency (RF) ablation of primary hepatic tumors by univariate and multivariate analyses, and to assess the therapeutic efficacy of Radio-frequency ablation.
A total of 172 patients with primary hepatic tumors underwent RF treatment in our department between 1999 and 2004. Among them, 150 patients were not the surgery candidates. The follow-up period ranged from 4 to 51 months and follow-up rate was 94.8% (163 patients). Kaplan-Meier model and log-rank test were used in univariate analyses and COX regression model was used in multivariate analyses, to identify prognostic factors for survival.
The survival rates at half a year, 1 year, 2 year and 3 year were 91.5%, 77.4%, 55.7% and 51.2% respectively. Using univariate analyses, 24 potential factors were analyzed and 8 of them were found significant for survival. These 8 factors were Child-Pugh grade, UICC stage, AFP value before first RF, Portal hypertension, first treatment or treatment for recurrence, pathological grade, treatment purpose and method, ablative safe margin. For 116 patients who underwent RF when first diagnosis, the survival rates in patients with different tumor stage (UICC standard of hepatocellular carcinoma) at half a year, 1 year, 2 year and 3 year were estimated as follows: 96.7%, 92.3%, 81.6% and 65.3% in 33 patients of stage I-II; 91.2%, 76.3%, 56.6% and 51.4% in 83 patients of stage III-IV; There was significant difference in survival rates between patients of stage I-II and patients of stage III-IV. For 56 patients suffered from recurrent hepatic tumors, the survival rates at half a year, 1 year, 2 year and 3 year were 88.5%, 70.2%, 41.4% and 24.5%, being similar to those of stage III-IV. The 8 factors mentioned above were further analyzed by multivariate model and 3 of them were identified as prognostic factors for survival. These 3 factors included Child-Pugh grade, Portal hypertension, treatment purpose and method.
Based on our statistical analysis, the prognostic factors on outcome in Radio-frequency ablation of hepatic tumors were grouped into two categories. Child-Pugh grade, and Portal hypertension were the characteristics of patients and uncontrollable. While treatment purpose and method also had significant impact on survival and was controllable during RF procedure. This information might be useful to improve treatment level of Radio-frequency ablation of hepatic tumors.
Zhonghua yi xue za zhi 09/2005; 85(33):2322-6.
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ABSTRACT: To assess the efficiency and safety of radiofrequency ablation (RFA) of recurrent hepatocellular carcinoma (RHCC) after hepatectomy and to investigate efficacy of RFA for patients with early and late phase recurrence, separately, setting 1 year as the cut-off between the early and late phases.
A total of 42 patients with 77 RHCC and a history of hepatic resection for hepatocellular carcinoma (HCC) underwent ultrasound-guided percutaneous radiofrequency ablation in our department and entered this study (RHCC group). The average diameter of RHCC was (3.8 +/- 1.4) cm (range, 1.5-6.6 cm). 21 of the 42 RHCC patients had Child-Pugh class A cirrhosis 19, class B and two, class C cirrhosis. The average interval between initial surgery and the diagnosis of recurrence was 22.8 months (range, 1-96 month). 42 RHCC patients were divided into two groups as early recurrence group including 20 patients with 40 RHCC, and late recurrence group including the other 22 patients with 37 RHCC according to the recurrence interval. During the same period 148 patients with 217 primary HCC were also treated by RF ablation and regarded as primary HCC group. The average diameter of primary HCC was (4.0 +/- 1.4) cm (range, 1.2-7.0 cm). Regular follow-up with enhanced CT was performed to evaluate the treatment results. Ablation was considered a success if no contrast enhancement was detected in the treated area on 1 month CT scans.
The ablation success rate, local recurrence rate, new tumor incidence and mean survival in RHCC group were 90.5%, 14.3%, 38.1% and (28.0 +/- 3.5) months, respectively, which were similar to the corresponding results of 87.2%, 16.2%, 37.8% and (39.0 +/- 2.1) month in primary HCC group. However, when further comparison was performed between early recurrence group, late recurrence group and primary HCC group, there were some significant differences. The incidence of new tumors in early recurrence group was significantly higher than that in late recurrent group (60.0% vs. 18.2%, P = 0.005); early recurrence group survived shorter than primary HCC group [(15.4 +/- 2.3) vs. (39.0 +/- 2.1) months, P < 0.005]. The survival time was similar between late recurrence group and primary HCC group. One case was found haemorrhage after RFA and recovered with conservative treatment. No major complications occurred in the remaining 41 patients.
RF ablation is generally effective and safe in treating RHCC. And it's more effective in late recurrence than in early recurrence.
Zhonghua wai ke za zhi [Chinese journal of surgery] 09/2005; 43(15):980-4.
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ABSTRACT: Previously, treatment outcome evaluation of hepatocellular carcinoma (HCC) was focused on cure rate, survival rate, and survival time. The quality of life (QOL) of cancer patients has been emphasized during the past decade, and used to evaluate treatment outcome of cancer and chronic disease. This study aimed to evaluate the QOL of HCC patients treated with radiofrequency ablation (RFA), and compare with that of patients treated with transcatheter arterial chemoembolization (TACE) or TACE in combination with RFA.
A QOL questionnaire (QOL-LC V2.0) was used on 160 HCC patients, in which 80 patients underwent RFA (RFA group), 40 underwent TACE (TACE group), and 40 underwent TACE in combination with RFA (combination group). The 3 groups were comparable in distributions of age, gender, clinical stage, and so on.
The median overall QOL score was higher in RFA group and combination group than in TACE group (168.6 vs. 146.8, P=0.025; 162.8 vs. 146.8, P>0.05). The median QOL score in symptom/side effect domain was significantly higher in RFA group and combination group than in TACE group (45.5 and 46.0 vs. 38.1, P<0.01). The physical score was slightly higher in RFA group and combination group than in TACE group. Spearman's correlation analysis showed that age, income, liver function, tumor recurrence, and complications were related to the QOL of HCC patients after treatment. The degree of liver function damage, complications, and tumor recurrence were significantly higher in TACE group than in RFA group (P<0.05). The 1-, 2-, and 3-year survival rates of RFA group were significantly higher than those of TACE group (92.8% vs. 74.3%, 89.3% vs. 48.2%, and 76.5% vs. 48.2%, P=0.041), but had no significant difference with those of combination group (94.1%, 87.4%, and 60.0%).
RFA is an effective and micro-invasive treatment for liver cancer. Compare with TACE alone, TACE in combination with RFA may decrease liver function damage and improve QOL of HCC patients.
Ai zheng = Aizheng = Chinese journal of cancer 08/2005; 24(7):827-33.
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ABSTRACT: To investigate the relationship of serum metalloproteinase with the severity of liver fibrosis and inflammation.
A total of 88 patients with HBV-related liver fibrosis and early cirrhosis were enrolled from six hospitals. Serum fibrosis markers including hyaluronic acid (HA), IV collagen (IV-C), aminoterminal propeptide of type III procollagen (PIIIP), laminin (LN), matrix metalloproteinases (MMP) 1, 2, 9 and tissue inhibitors of metalloproteinase (TIMP) 1, 2 levels were determined. Liver biopsies were assessed according to a modified Scheuer and Chevallier's scoring system.
Serum TIMP1 (r=0.540) and MMP2 (r=0.314) were correlated positively with the degree of hepatic fibrosis, whereas serum MMP1 (r=-0.495) was correlated negatively. By receiver operating curve analysis (ROC), the sensitivity to distinguish the fibrosis stage 2 from stage 1 was 90.5% and the specificity was 52.0% if the cut-off value of MMP1 was 13.96 ng/ml, and the sensitivity was 91.6% and the specificity was 64.0% if the cut-off value of TIMP1 was 76.84 ng/ml. The sensitivity to distinguish cirrhosis (stage 4) from fibrosis (stage 3) was 70.7% and specificity was 80.9% if the cut-off value of MMP1 was 6.86 ng/ml, and the sensitivity was 60.5% and the specificity was 92.3% if the cut-off value of TIMP1 was 210.04 ng/ml.
Serum TIMP1, MMP1, MMP2 levels and TIMP1/MMP1 ratio could be used as serum fibrosis markers.
Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology 12/2004; 12(11):666-8.
