Stereotactic radiofrequency ablation of hepatocellular carcinoma ‐ A histopathological study in explanted livers

Abstract

Background and Rationale for the study

This retrospective study was performed to evaluate the efficacy of 3D‐navigated multi‐probe radiofrequency ablation (RFA) with intraprocedural image fusion for the treatment of hepatocellular carcinoma (HCC) by histopathologic examination.

Main Results

From 2009 to 2018, 97 patients (84 men, 13 women; median age 60 years, range 1 –71) were transplanted after bridging therapy of 195 HCCs by stereotactic RFA (SRFA). The median interval between the first SRFA and transplantation was 6.8 months (range: 0 – 71). The rate of residual vital tissue (RVT) could be assessed in 188/195 lesions in 96/97 patients by histological examination of the explanted livers using Hematoxylin & Eosin (H&E) and TUNEL stains. The histopathologic results were compared with the findings of the last CT imaging prior to LT. The median number and size of the treated tumors were 1 (range: 1‐8) and 2.5 cm (range: 1‐8 cm). Complete radiological response was achieved in 186/188 nodules (98.9%) and 94/96 patients (97.9%) and complete pathological response in the explanted liver specimen in 183/188 nodules (97.3%) and 91/96 patients (94.8%), respectively. In lesions ≥3 cm complete tumor cell death was achieved in 50/52 nodules (96.2%). Residual tumor did not correlate with tumor size (p = 0.5).

Conclusions

Multi‐probe SRFA with intraprocedural image fusion represents an efficient minimal invasive therapy for HCC, even with tumor sizes larger than 3cm, and without the need of a combination with additional treatments. The results seem to justify the additional efforts related to the stereotactic approach.

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