Percutaneous Liver Tumour Ablation: Image Guidance, Endpoint Assessment, and Quality Control

• Published in: Canadian Association of Radiologists journal 2018-02, Vol.69 (1), p.51-62
• Main Authors: Puijk, Robbert S., Ruarus, Alette H., Scheffer, Hester J., Vroomen, Laurien G.P.H., van Tilborg, Aukje A.J.M., de Vries, Jan J.J., Berger, Ferco H., van den Tol, Petrousjka M.P., Meijerink, Martijn R.
• Format: Article
• Language: English
• Subjects: Ablation; Ablation Techniques - methods; Algorithms; Conspicuity; Effectiveness; Electroporation; Hepatectomy; Humans; Image guidance; Image quality; Intervention; Liver; Liver - diagnostic imaging; Liver - surgery; Liver cancer; Liver diseases; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - surgery; Microwave ablation; Patients; Percutaneous liver tumour ablation; Quality assessment; Quality Control; Radio frequency; Radiofrequency ablation; Radiology; Radiology, Interventional - methods; Survival; Therapeutic applications; Treatment Outcome; Tumors
• ISSN: 0846-5371; 1488-2361
• DOI: 10.1016/j.carj.2017.11.001

Liver tumour ablation nowadays represents a routine treatment option for patients with primary and secondary liver tumours. Radiofrequency ablation and microwave ablation are the most widely adopted methods, although novel techniques, such as irreversible electroporation, are quickly working their way up. The percutaneous approach is rapidly gaining popularity because of its minimally invasive character, low complication rate, good efficacy rate, and repeatability. However, matched to partial hepatectomy and open ablations, the issue of ablation site recurrences remains unresolved and necessitates further improvement. For percutaneous liver tumour ablation, several real-time imaging modalities are available to improve tumour visibility, detect surrounding critical structures, guide applicators, monitor treatment effect, and, if necessary, adapt or repeat energy delivery. Known predictors for success are tumour size, location, lesion conspicuity, tumour-free margin, and operator experience. The implementation of reliable endpoints to assess treatment efficacy allows for completion-procedures, either within the same session or within a couple of weeks after the procedure. Although the effect on overall survival may be trivial, (local) progression-free survival will indisputably improve with the implementation of reliable endpoints. This article reviews the available needle navigation techniques, evaluates potential treatment endpoints, and proposes an algorithm for quality control after the procedure. De nos jours, l'ablation de tumeurs hépatiques primitives et secondaires est une option thérapeutique courante pour les patients qui en sont atteints. Les méthodes d'ablation par radiofréquence et par micro-ondes sont les plus répandues, mais des techniques novatrices, comme l’électroporation irréversible, gagnent rapidement du terrain. Il en va de même pour la méthode percutanée en raison de sa nature peu effractive, de son bon taux de réussite et de sa répétabilité. Cependant, lorsqu'elle est associée à l'hépatectomie partielle et à l'ablation par chirurgie ouverte, elle entraîne des problèmes de récurrence au site d'ablation encore non résolus et doit donc être améliorée. Dans le cas de l'ablation percutanée de tumeurs hépatiques, plusieurs modalités d'imagerie en temps réel permettent d'améliorer la visibilité de la tumeur, de détecter les structures critiques voisines, de guider les applicateurs, de surveiller les effets du traitement et, au besoin, de mod