OBJECTIVETo investigate the clinical value of enhanced ultrasonography before and after ultrasound guided radiofrequency ablation (RFA) of hepatomas.

METHODSEighteen patients with 17 primary hepatocellular carcinoma and 1 hepatic metastasis were studied. Sixteen were confirmed by operation or needle puncture biopsy, 2 by clinical examinations including CT scanning, MRI etc. New contrast agent, SonoVue, Technos DU6 and Contrast Tuned Imaging (CnTI) technique were adopted. Enhanced ultrasonography was performed before or after the RFA procedure.

RESULTSTwenty-six lesions were observed with enhanced ultrasonography before RFA, 24 of which showed ball-carrying sign or diffuse enhancement at the early artery phase favoring the fast diagnosis; 9 lesions showed feeding vessels; twelve of the 26 lesions (46.2%) tended to be larger, especially those with unclear margins (78.6%, 11/14) and those without halo sign (68.8%, 11/16). Enhanced ultrasonography revealed 13 satellite foci in four cases which had been undetectable with routine ultrasound, CT scanning or MRI. The final diagnosis of either inactivation or residual disease would rely upon more than two kinds of images, levels of tumor marks, biopsy pathology and more than 7 months of follow-up. Twenty-two lesions were observed with enhanced ultrasonography after RFA, with an accuracy of 95.5% (21/22), being similar to the enhanced CT and was significantly superior to the routine color ultrasonography whose accuracy was only 63.6% (14/22).

CONCLUSIONEnhanced ultrasonography may provide more information on the characters, size, number and feeding vessels of the tumor before radiofrequency ablation, thus helping choose the indicator, establish and carry out the treatment protocol. This technique may also help to assess the therapeutic response to RFA.

Adult ; Aged ; Carcinoma, Hepatocellular ; diagnostic imaging ; pathology ; surgery ; Catheter Ablation ; Female ; Humans ; Liver Neoplasms ; diagnostic imaging ; pathology ; surgery ; Male ; Middle Aged ; Ultrasonography

OBJECTIVETo retrospectively investigate the feasibility of radiofrequency ablation (RFA) in treating advanced hepatocellular carcinoma (HCC) using standard ultrasound-guided percutaneous RFA.

METHODSA total of 655 patients with unresectable advanced HCC underwent ultrasound-guided percutaneous RFA therapy at our institution between July 2000 to September 2001. Ninety-two of those patients, representing 136 tumors, were selected for analysis based on the following criteria: presence of UICC/AJCC-TNM (6th edition) stage III and IV advanced HCC, (III: n=82 patients, with 126 tumors; IV: n=10 patients, with 10 tumors); extensive portal vein or inferior vena cava tumor thrombus; extrahepatic metastasis after surgical resection; and complete follow-up data. Follow-up consisted of enhanced computed tomography (CT) performed at one month post-RFA treatment, then every three months. Contrast-enhanced ultrasound (CEUS) was performed in 51 (55.4%) patients before RFA. The standard treatment using optimal strategies were applied in (72.8%) 67 patients. The established strategies included: (1) select RFA indications based on CEUS results; (2) design radical protocols based on invasive range showed by CEUS; (3) multiple overlapping ablations based on mathematical protocols; (4) two or three bipolar RFA electrodes with three-dimensional localization; (5) color ultrasound-guided percutaneous ablation of tumor feeding artery (PAA)/transcatheter arterial chemoembolization (TACE) + RFA for HCC with rich supply. The other 25 patients (27.2 %) were treated with conventional RFA protocols. The ablation procedure was considered a success if no abnormal enhancement or wash-out was detected in the treated area on the CT scan at one month. All patients had received liver protection treatments following RFA. Chi-squared test or Fisher's exact test were used to compare the early complete tumor necrosis rates and the local recurrence rates. Survival was estimated by Kaplan-Meier analysis and log-rank test. P less than 0.05 was considered statistically significant.

RESULTSThe RFA-treated tumors ranged in size from 1.5 to 7.0 cm (average: 4.5 cm). Fifty-nine patients had solitary tumor, and the remaining 33 had multiple tumors (2 to 4 tumors). Patients were classified by Child-Pugh score as A (n=58), B (n=32) and C (n=2). Early complete tumor necrosis rate after initial RFA was 90.4% (123/136 tumors). Serious complications developed in two patients (2.2%). No treatment-related death occurred. Follow-up ranged from 3-134 months. Local recurrence rate was 16.9% (23/136 tumors). The 1-, 3- and 5-year overall survival rates were 83.3%, 48.3% and 21.9%, respectively, and the median survival time was 35 months. Stratification analysis indicated the early complete tumor necrosis rate was higher in groups of patients with Child-Pugh A score (98.3%) , CEUS administration (98.0%), and standard treatment (97.0%). The local recurrence rate was lower in groups of patients with tumors less than or equal to 3.0 cm (5.9%), CEUS administration (11.8%), and standard treatment (16.4%). The 5-year survival was significantly higher in patients with Child-Pugh A, tumors less than or equal to 3.0 cm, CEUS administration, and standard treatment (all, P less than 0.05).

CONCLUSIONRFA treatment of patients with advanced HCC, tumors less than 7.0 cm, and without thrombosis in the main vessels was efficacious. The RFA treatment strategy and subsequent liver protection therapy in RFA may improve survival.

Adult ; Aged ; Aged, 80 and over ; Carcinoma, Hepatocellular ; pathology ; surgery ; Catheter Ablation ; methods ; Female ; Humans ; Liver Neoplasms ; pathology ; surgery ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Ultrasonography, Interventional

Hepatocellular adenoma (HA) is a benign hepatic lesion that predominantly occurs in young women. Most hepatocellular carcinomas (HCC) arise in a cirrhotic liver during the fifth or sixth decades. There have been several reported cases of HCC developing from HA in female patients. However, there are rare cases about HCC arising in HA in a non-cirrhotic male patient. We have recently encountered a 53-year-old man who had a liver mass in a non-cirrhotic liver, and the liver mass was compatible with HA on the pre-operative computed tomography. The mass was completely resected and the histopathology revealed a focus of HCC arising in HA. We report here on this case along with a brief review of the relevant literature
Adenoma, Liver Cell/*pathology/surgery ; Adult ; Biopsy ; Carcinoma, Hepatocellular/*pathology/surgery ; Female ; Hepatectomy ; Humans ; Liver Neoplasms/*pathology/surgery ; Male ; Middle Aged ; Precancerous Conditions/*pathology/surgery ; Tomography, X-Ray Computed ; Treatment Outcome ; Ultrasonography ; Young Adult

BACKGROUND/AIMS: To investigate sequential changes in laboratory markers after radiofrequency ablation (RFA) of hepatocellular carcinoma (HCC) and the relationship of these changes to the severity of the underlying liver disease. METHODS: This retrospective analysis included 65 patients (44 males, 21 females) who underwent RFA of HCC. Hematologic and biochemical markers were assessed at the pre-RFA period and 1 day, 2-3 days, and 1-2 weeks after RFA. We classified the subjects into two groups: Child-Pugh A (n=41) and Child-Pugh B (n=24). The ablative margin volume (AMV) of each patient was measured. We analyzed the changes in laboratory profiles from the baseline, and investigated whether these laboratory changes were correlated with the AMV and the Child-Pugh classification. RESULTS: Most of the laboratory values peaked at 2-3 days after RFA. AMV was significantly correlated with changes in WBC count, hemoglobin level, and serum total bilirubin level (Pearson's correlation coefficient, 0.324-0.453; P<0.05). The alanine aminotransferase (ALT) level varied significantly over time (P=0.023). CONCLUSIONS: Most of the measured laboratory markers changed from baseline, peaking at 2-3 days. The ALT level was the only parameter for which there was a significant difference after RFA between Child-Pugh A and B patients: it increased significantly more in the Child-Pugh A patients.
Adult ; Aged ; Aged, 80 and over ; Alanine Transaminase/blood ; Bilirubin/blood ; Biomarkers/metabolism ; Carcinoma, Hepatocellular/pathology/*surgery/ultrasonography ; Catheter Ablation ; Female ; Follow-Up Studies ; Humans ; Liver Neoplasms/pathology/*surgery/ultrasonography ; Male ; Middle Aged ; Retrospective Studies ; Severity of Illness Index

OBJECTIVETo explore the value of ultrasound-guided percutaneous radiofrequency ablation (RFA) in designing the indication, treatment protocol and operational skills for patients with primary hepatocellular carcinoma (HCC) near the liver surface.

METHODSSixty-one HCC patients with 69 lesions, confirmed by clinical examination and pathology, underwent percutaneous radiofrequency ablation. The study included 40 cases of liver function Child-Pugh grade A and 21 cases of grade B. The average size of tumors was (3.8 ± 1.2) cm, tumor diameter ≥ 4 cm accounted for 39.1% (27/69 lesions), and the average age was 58.2 years (range, 35-76 years). Taking comprehensive measures, such as intraperitoneal injection of saline adjacent to the tumor before RFA, increasing the puncture sites on the surface of tumor to avoid overlapping of the central portion of tumor, repeated ablation of the needle track to reduce needle tract metastasis, avoid vertical puncture, and other additional measures, to improve the inactivation of tumors adjacent to the liver surface. Enhanced CT/MRI was performed to evaluate the curative effect at 1, 3, 6 and 24 months after the treatment.

RESULTSThe inactivation rate of tumor was 98.6% (68/69 lesions) and local recurrence rate was 5.8%(4/69) after RFA. The tumor-related marker AFP was 1 000-1 500 ng/ml before and reduced to (98.5 ± 42.5) ng/ml after radiofrequency ablation, among them returned to normal in 13 cases (21.3%). Since the ablation area was rather small, the level of serum alanine aminotransferase was elevated only to (148.5 ± 38.5) U/ml at one week after RFA and returned to normal at (1.8 ± 0.6) week after RFA. No patient experienced severe liver dysfunction. The local HCC recurrent rate after RFA was 5.8%(4/69 lesions) and intrahepatic heterotopic recurrence rate was 24.6% (15/61). The 20-61 months follow-up showed that the 1-, 2- and 3-year survival rate was 83.6%, 57.3% and 44.2%, respectively.

CONCLUSIONSUltrasound-guided percutaneous radiofrequency ablation provides an effective minimally invasive treatment for primary HCC near the liver surface. Taking some additional measures such as intraperitoneal injection of saline, increase of percutaneous puncture sites, and avoiding vertical needle puncture, may reduce complications and improve the therapeutic outcome. RFA is one of effective and minimally invasive treatment and causing less liver damage for primary HCC near the liver surface.

Adult ; Aged ; Biomarkers, Tumor ; blood ; Carcinoma, Hepatocellular ; blood ; pathology ; surgery ; Catheter Ablation ; methods ; Humans ; Liver ; pathology ; Liver Neoplasms ; blood ; pathology ; surgery ; Magnetic Resonance Imaging ; methods ; Middle Aged ; Neoplasm Recurrence, Local ; Survival Rate ; Treatment Outcome ; Tumor Burden ; Ultrasonography, Interventional

BACKGROUNDFew reports have evaluated the efficacy of re-operation for relapse after initial surgery for hepatocellular carcinoma (HCC) with bile duct thrombosis (BDT). The aim of this study was to investigate the efficacy of initial surgery and subsequent re-operation for HCC with BDT, and their effects on prognosis.

METHODSThe clinical data of 880 patients with HCC, including 28 patients with BDT, who underwent radical hepatectomy between 1998 and 2008 in our hospital, were reviewed. The effects of BDT and re-operation on prognosis were retrospectively analyzed.

RESULTSThe 1-, 3- and 5-year survival rates were 89.3%, 46.4% and 21.4%, respectively, in 28 patients with BDT versus 91.4%, 52.9% and 20.9% in 852 patients without BDT (P>0.05). Six patients with BDT underwent re-operation after disease relapse, and their survival time was significantly longer than those who did not undergo re-operation (P<0.05). Multivariate analysis indicated that portal vein invasion and tumor size were independently associated with tumor relapse and prognosis (P<0.05). Univariate analysis and multivariate analyses showed that obstructive jaundice was not significantly correlated with tumor relapse or prognosis (P>0.05).

CONCLUSIONSHepatectomy plus BDT removal is an effective treatment option for HCC with BDT. Obstructive jaundice is not a contraindication for surgery. Re-operation after relapse can provide good outcomes if the cases are appropriately selected.

Adult ; Bile Ducts ; pathology ; Carcinoma, Hepatocellular ; diagnostic imaging ; surgery ; Female ; Hepatectomy ; Humans ; Liver Neoplasms ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Thrombosis ; surgery ; Treatment Outcome ; Ultrasonography

OBJECTIVETo explore the feasibility, effect and problems of percutaneous radiofrequency ablation (PRFA) performed for small liver cancer located in hepatis.

METHODSTwenty-one patients, who had small primary or metastatic liver cancer confirmed clinically or pathologically that were located in hepatis and less than 5 cm, were performed PRFA between April 2000 and October 2002. All patients were followed up to examine the value of AFP, MRI or CT. Kaplan-Meier estimation was used for the disease-free survival rate and the long-term survival rate.

RESULTSThe rate of AFP positive down to negative was 77.8% (7/9). The complete necrosis rate was 90.5% (19/21). The peri-tumor recurrence-free survival rates of 0.5-, 1-, 1.5-, 2-year were all 94.7%. The distant recurrence-free survival rates of 0.5-, 1-, 1.5-, 2-year were 90.0%, 77.1%, 77.1% and 77.1% respectively. The whole survival rates of 0.5-, 1-, 1.5- and 2-year were 89.2%, 82.8%, 82.8% and 55.2% respectively.

CONCLUSIONSSmall liver cancer located in hepatis was not the contra-indication of PRFA. If the puncture point and route is selected properly, electrodes outspreaded exactly and the range of heating controlled appropriately, PRFA is an effective method and of less complication rate for small liver cancer located in hepatis. Sometimes, PRFA can be combined with TACE for those tumors of the diameter larger than 3 cm.

Adult ; Aged ; Carcinoma, Hepatocellular ; mortality ; surgery ; Catheter Ablation ; Disease-Free Survival ; Female ; Humans ; Liver ; diagnostic imaging ; pathology ; Liver Neoplasms ; mortality ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Survival Rate ; Treatment Outcome ; Ultrasonography

OBJECTIVETo study the clinicopathologic features of focal nodular hyperplasia (FNH) of liver.

METHODSThe clinical, radiologic, pathologic findings and follow-up data of 238 cases of FNH were retrospectively analyzed.

RESULTSThe patients included 93 females and 145 males. The age of the patients ranged from 11 to 77 years (median = 39.1 years). Amongst the 233 patients who had clinical information available, 188 were asymptomatic, 216 had no history of hepatitis B and/or C infection and 232 had negative serum alpha-fetoprotein level. Amongst the 185 patients who had undergone radiologic examination, 123 (66.5%) were accurately diagnosed as such. Macroscopically, of the 284 lesions from 238 patients, the average diameter was 3.7 cm. Two hundred and fifteen cases (90.3%) were solitary, 172 cases were located in the right lobe and 115(40.5%) had central stellate fibrotic scars or lobulated cut surface. Histologically, 229 lesions belonged to classic type and 9 lesions were of non-classic type. The latter was further classified as the telangiectatic form (6 lesions) and the mixed hyperplastic and adenomatous form (3 lesions). There was no evidence of significant cytologic atypia. Follow-up data were available in 173 patients (72.7%). None of them died of the disease and 2 patients suffered from relapses after 2 and 4 years, respectively.

CONCLUSIONSFNH is a hyperplastic response of normal liver cells to local blood flow anomalies. It has no obvious sex predilection and more than 66% can be diagnosed accurately with radiologic examination. The lesions in the current study show no cytologic atypia.

Adenoma, Liver Cell ; pathology ; Adolescent ; Adult ; Aged ; Biopsy ; Carcinoma, Hepatocellular ; pathology ; Child ; Diagnosis, Differential ; Female ; Focal Nodular Hyperplasia ; diagnosis ; diagnostic imaging ; pathology ; surgery ; Follow-Up Studies ; Humans ; Liver ; pathology ; Liver Neoplasms ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Recurrence ; Retrospective Studies ; Tomography, X-Ray Computed ; Ultrasonography ; Young Adult

BACKGROUND AND OBJECTIVEPercutaneous ultrasound-guided thermal ablation is one of the major treatment methods for liver cancer. Tumor location close to the diaphragm or gastrointestinal tract was regarded as the treatment contraindication before due to poor visibility of the tumor or increased risk of thermal injury to the adjacent organs. This study used artificial pleural effusion or ascites to extend the indications of thermal ablation for liver cancer.

METHODSArtificial pleural effusion (20 cases) or ascites (36 cases) was performed in 56 difficult cases of percutaneous thermal ablation for liver tumors. The technical success rates, the rate of approaching the procedure goal, complications, and local treatment response were assessed.

RESULTSThe technical success rates were 95% (19/20) for artificial pleural effusion and 100% (36/36) for artificial ascites, the achieve purpose rates were 100% (19/19) and 91.7% (33/36), the complete ablation rates were 84.2% (16/19) and 93.9% (31/33), respectively. Coughing, transient hematuria, and subcutaneous effusion were observed in 3 patients after the procedure of artificial pleural effusion, and hydrothorax in the right chest occurred in 1 patient during the artificial ascites process.

CONCLUSIONSThermal ablation with the use of artificial pleural effusion or ascites is a safe and effective treatment for liver tumors, and the technique can widen the indications of thermal ablation for liver tumors.

Adult ; Aged ; Aged, 80 and over ; Ascites ; Carcinoma, Hepatocellular ; diagnostic imaging ; pathology ; secondary ; surgery ; Catheter Ablation ; adverse effects ; methods ; Colorectal Neoplasms ; pathology ; Cough ; etiology ; Female ; Glucose ; administration & dosage ; Hematuria ; etiology ; Humans ; Liver Neoplasms ; diagnostic imaging ; pathology ; secondary ; surgery ; Male ; Microwaves ; Middle Aged ; Pleural Effusion ; Ultrasonography, Interventional ; Young Adult