Can Tumor Recurrence Be Predicted by Magnetic Resonance Imaging Findings Before Microwave Ablation in Patients with Hepatocellular Carcinoma?

Year 2024, Volume: 14 Issue: 3, 276 - 281, 30.09.2024

Mustafa Özdemir

https://doi.org/10.31832/smj.1473967

Abstract

Objective: Hepatocellular carcinoma (HCC) is a common cancer. The primary treatment is surgery or liver transplantation. Percutaneous ablation techniques constitute the primary treatment in patients who are not suitable for surgery. Although it gives successful results, some studies report a recurrence rate of up to 50%. This study aimed to obtain an idea about the possibility of possible recurrence by evaluating the lesion characteristics in the pre-procedural MRI images of patients with and without recurrence.
Methods: Forty-eight patients who underwent microwave ablation for HCC in our center between 2018 and 2021 were included in the study. Lesion size, presence of peripheral enhancement, arterial contrast enhancement, and T2 signal characteristics were evaluated on pre-procedural MRI. Subsequently, the relationship of these features with tumor recurrence was evaluated.
Results: The risk of recurrence was higher in patients with lesion sizes with larger than 3 cm diameter and in lesions showing peripheral contrast enhancement (p= 0.036 and p= 0.021, respectively).
Conclusion: Close follow-up will be beneficial in HCCs larger than 3 cm and showing peripheral enhancement since there is a high probability of recurrence after ablation.

Keywords

Hepatocellular carcinoma, Microwave ablation, MRI

Can Tumor Recurrence Be Predicted by Magnetic Resonance Imaging Findings Before Microwave Ablation in Patients with Hepatocellular Carcinoma?

Abstract

Purpose: Hepatocellular carcinoma (HCC) is a common cancer. The primary treatment is surgery or liver transplantation. Percutaneous ablation techniques constitute the primary treatment in patients who are not suitable for surgery. Although it gives successful results, some studies report a recurrence rate of up to 50%. This study aimed to obtain an idea about the possibility of possible recurrence by evaluating the lesion characteristics in the pre-procedure MRI images of patients with and without recurrence.
Methods: Forty-eight patients who underwent microwave ablation for HCC in our center between 2018 and 2021 were included in the study. Lesion size, presence of peripheral enhancement, arterial contrast enhancement, and T2 signal characteristics were evaluated on MRI. Subsequently, the relationship of these features with tumor recurrence was evaluated.
Results: When lesions with and without recurrence were compared during follow-up, it was shown that the risk of recurrence was high in patients with lesion sizes larger than 3 cm and in lesions showing peripheral contrast enhancement (p 0.036 and p 0.021, respectively).
Conclusion: Since there is a high probability of recurrence after ablation in HCCs larger than 3 cm and showing peripheral contrast, close follow-up will be beneficial.

Keywords

hepatocellular carcinoma, microwave ablation, MRI

References

• Akarca US, Unsal B, Sezgin O, Yalcin K, Akdogan M, Gonen C, et al. Characteristics of Newly Diagnosed Hepatocellular Carcinoma Patients Across Turkey: Prospective Multicenter Observational 3K Registry Study. Turk J Gastroenterol. 2021;32(12):1019-1028
• Can A, Dogan E, Bayoglu IV, Tatli AM, Besiroglu M, Kocer M, et al. Multicenter epidemiologic study on hepatocellular carcinoma in Turkey. Asian Pacific journal of cancer prevention: APJCP, 2014;15(6): 2923–2927.
• Erdogan AP, Ekinci F, Özveren A, Çelik C, Ateş GA, Akay S, et al. Hepatosellüler Karsinomda Klinik ve Prognostik Özelliklerin Değerlendirilmesi: Tek Merkez Deneyimi. Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi, 2021; 8(3): 410-413.
• Gadsden MM, Kaplan DE. Multidisciplinary Approach to HCC Management: How Can This Be Done? Digestive diseases and sciences, (2019); 64(4): 968–975.
• Izzo F, Granata V, Grassi R, Fusco R, Palaia R, Delrio P et al. Radiofrequency Ablation and Microwave Ablation in Liver Tumors: An Update. The Oncologist. 2019;24(10):2018- 0337
• Mitchell DG, Bruix J, Sherman M, Sirlin CB. LI‐RADS (Liver Imaging Reporting and Data System): Summary, discussion, and consensus of the LI‐RADS Management Working Group and future directions. Hepatology. 2014;61(3):1056-1065.
• Couillard AB, Knott EA, Zlevor AM, Mezrich JD, Cristescu MM, Agarwal P, et al. Microwave Ablation as Bridging to Liver Transplant for Patients with Hepatocellular Carcinoma: A Single-Center Retrospective Analysis. Journal of vascular and interventional radiology. 2022;33(9):1045-1053.
• Wang X, Yu H, Zhao F, Xu Y, Wang C, Liu K, et al Microwave ablation versus radiofrequency ablation as bridge therapy in potentially transplantable patients with single HCC ≤ 3 cm: A propensity score-matched study. Eur J Radiol. 2023;164:110860.
• Sun AX, Cheng ZL, Wu PP, Sheng YH, Qu XJ, Lu W, et al Clinical outcome of medium-sized hepatocellular carcinoma treated with microwave ablation. World J Gastroenterol. 2015;21(10):2997-3004.
• Sheng RF, Zeng MS, Ren ZG, Ye SL, Zhang L, Chen CZ. Intrahepatic distant recurrence following complete radiofrequency ablation of small hepatocellular carcinoma: Risk factors and early MRI evaluation. Hepatobiliary Pancreat Dis Int. 2015;14(6):603-612.
• Baker EH, Thompson K, McKillop IH, Cochran A, Kirks R, Vrochides D, et al. Operative microwave ablation for hepatocellular carcinoma: A single center retrospective review of 219 patients. J Gastrointest Oncol. 2017;8(2):337-346.
• Chu W, Li P, Wu X, Zhang P, Zhou H, Niu B. Risk factors for recurrence beyond Milan criteria after radiofrequency ablation in transplantable small hepatocellular carcinoma. Rev Esp Enferm Dig. 2022;114(10):580-585.
• Dong T, Nie F, Liu T, Wang L, Yang D, Yan X. Different power modes of microwave ablation for hepatocellular carcinoma: Evaluation of recurrence rate and factors related to recurrence. Asian J Surg. 2023;46(9):3520- 3528.
• Öcal O, Schütte K, Malfertheiner P, Berg T, Loewe C, Klümpen HJ, et al. Prognostic value of baseline MRI features in patients treated with thermal ablation for hepatocellular carcinoma. Eur J Radiol. 2023;168:111120.
• Takigawa A, Sakamori R, Tahata Y, Yoshioka T, Yamada R, Kodama T, et al. Prediction Model for Intrahepatic Distant Recurrence After Radiofrequency Ablation for Primary Hepatocellular Carcinoma 2 cm or Smaller. Dig Dis Sci. 2022;67(12):5704-5711.