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The Role of a Curved Electrode with Controllable Direction in the Radiofrequency Ablation of Liver Tumors Behind Large Vessels

  • An-Na Jiang
  • Song Wang
  • Wei YangEmail author
  • Kun Zhao
  • Xiu-Mei Bai
  • Zhong-Yi Zhang
  • Wei Wu
  • Min-Hua Chen
  • Kun Yan
Laboratory Investigation

Abstract

Purpose

To investigate the role of a novel curved radiofrequency ablation (RFA) electrode with controllable direction in the ablation of tumors behind large hepatic vessels in ex vivo bovine and in vivo canine liver experiments.

Materials and Methods

Approval from the institutional animal care and use committee was obtained. In ex vivo experiments, conventional multi-tines expandable electrodes, conventional monopolar straight electrodes and novel curved electrodes were used in the ablation of the bovine liver (n = 90). The ablated area, parallel axis, vertical axis and shape of different electrodes were compared. Then, 24 beagle dogs (10 months old, female) were used for in vivo experiments. Visual tumor targets deeply located in the portal vein were established, and ultrasound-guided liver ablation was performed with different electrodes. The ablation range, target coverage rate, percentage of normal tissue injury and damage to adjacent vessels were evaluated. The Kruskal–Wallis test and the Chi-squared test were used for statistical analysis.

Results

For the ex vivo study with a 3-cm electrode, the ablation area of the multi-tines expandable electrode group (7.14 ± 0.16 cm2) was significantly larger than that of the novel curved electrode group (5.01 ± 0.30 cm2, P < 0.001) and the monopolar straight electrode group (5.43 ± 0.15 cm2, P < 0.001). The results obtained with the 4-cm electrode in the three groups were in accordance with those of the 3-cm electrode. In vivo, the normal tissue damage area of the novel curved electrode group was smaller than that of the multi-tines expandable electrode group (1.10 ± 0.18 cm2 vs. 4.00 ± 0.18 cm2, P < 0.001). The target coverage rate of the novel curved electrode group was better than that of the monopolar straight electrode group (100% vs. 80.86 ± 1.68%, P < 0.001). The hematoxylin and eosin (H&E) and TUNEL staining results showed that the ablation necrosis area was adjacent to large vessels, but the vascular wall was not significantly damaged in the novel curved electrode group.

Conclusion

Our preliminary results showed that the novel curved RFA electrode with controllable direction could achieve accurate ablation for tumors behind large hepatic vessels, with a better target coverage rate and less damage to normal tissue, than conventional multi-tines expandable electrodes and monopolar straight electrodes.

Keywords

Radiofrequency ablation Electrode Controllable direction Hepatic vessel Target coverage rate 

Notes

Acknowledgements

This study was supported by the National Natural Science Foundation of China (No. 81773286) and the Capital Characteristic Clinical Application Foundation (No. Z161100000516061).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Standard

All procedures performed in studies involving animals were in accordance with the ethical standards of the Institutional Animal Care and Use Committee (Peking University, Cancer Hospital). All applicable institutional guidelines for the care and use of animals were followed.

Supplementary material

270_2019_2182_MOESM1_ESM.docx (467 kb)
Supplementary material 1 (DOCX 466 kb)

References

  1. 1.
    Ziemlewicz TJ, Wells SA, Lubner MG, Brace CL, Lee FT Jr, Hinshaw JL. Hepatic tumor ablation. Surg Clin North Am. 2016;96(2):315–39.  https://doi.org/10.1016/j.suc.2015.12.006.PubMedGoogle Scholar
  2. 2.
    Decadt B, Siriwardena AK. Radiofrequency ablation of liver tumours: systematic review. Lancet Oncol. 2004;5(9):550–60.  https://doi.org/10.1016/S1470-2045(04)01567-0.PubMedGoogle Scholar
  3. 3.
    Curley SA. Radiofrequency ablation of malignant liver tumors. Ann Surg Oncol. 2003;10(4):338–47.  https://doi.org/10.1634/theoncologist.6-1-14.PubMedGoogle Scholar
  4. 4.
    Lencioni R, Crocetti L. Radiofrequency ablation of liver cancer. Tech Vasc Interv Radiol. 2007;10(1):38–46.  https://doi.org/10.1053/j.tvir.2007.08.006.PubMedGoogle Scholar
  5. 5.
    Goldberg SN. Radiofrequency tumor ablation: principles and techniques. Eur J Ultrasound. 2001;13(2):129–47.  https://doi.org/10.1016/S0929-8266(01)00126-4.PubMedGoogle Scholar
  6. 6.
    McWilliams JP, Yamamoto S, Raman SS, Loh CT, Lee EW, Liu DM, Kee ST. Percutaneous ablation of hepatocellular carcinoma: current status. J Vasc Interv Radiol. 2010;21(8 Suppl):S204–13.  https://doi.org/10.1016/j.jvir.2009.11.025.PubMedGoogle Scholar
  7. 7.
    Ikeda K, Osaki Y, Nakanishi H, Nasu A, Kawamura Y, Jyoko K, Sano T, Sunagozaka H, Uchino K, Minami Y, Saito Y, Nagai K, Inokuchi R, Kokubu S, Kudo M. Recent progress in radiofrequency ablation therapy for hepatocellular carcinoma. Oncology. 2014;87(Suppl 1):73–7.  https://doi.org/10.1159/000368148.PubMedGoogle Scholar
  8. 8.
    Ni Y, Mulier S, Miao Y, Michel L, Marchal G. A review of the general aspects of radiofrequency ablation. Abdom Imaging. 2005;30(4):381–400.  https://doi.org/10.1007/s00261-004-0253-9.PubMedGoogle Scholar
  9. 9.
    Terraz S, Constantin C, Majno PE, Spahr L, Mentha G, Becker CD. Image-guided multipolar radiofrequency ablation of liver tumours: initial clinical results. Eur Radiol. 2007;17(9):2253e61.  https://doi.org/10.1007/s00330-007-0626-x.Google Scholar
  10. 10.
    Lin SM, Lin CC, Chen WT, Chen YC, Hsu CW. Radiofrequency ablation for hepatocellular carcinoma: a prospective comparison of four radiofrequency devices. J Vasc Interv Radiol. 2007;18(9):1118–25.  https://doi.org/10.1016/j.jvir.2007.06.010.PubMedGoogle Scholar
  11. 11.
    Fu JJ, Wang S, Yang W, Gong W, Jiang AN, Yan K, Chen MH. Protective and heat retention effects of thermo-sensitive basement membrane extract (matrigel) in hepatic radiofrequency ablation in an experimental animal study. Cardiovasc Intervent Radiol. 2017;40(7):1077–85.  https://doi.org/10.1007/s00270-017-1617-1.PubMedGoogle Scholar
  12. 12.
    Lee JD, Lee JM, Kim SW, Kim CS, Mun WS. MR imaging-histopathologic correlation of radiofrequency thermal ablation lesion in a rabbit liver model: observation during acute and chronic stages. Korean J Radiol. 2001;2(3):151–8.  https://doi.org/10.3348/kjr.2001.2.3.151.PubMedGoogle Scholar
  13. 13.
    Lee JM, Han JK, Lee JY, Kim SH, Choi JY, Lee MW, Choi SH, Eo H, Choi BI. Hepatic radiofrequency ablation using multiple probes: ex vivo and in vivo comparative studies of monopolar versus multipolar modes. Korean J Radiol. 2006;7(2):106–17.  https://doi.org/10.3348/kjr.2006.7.2.106.PubMedGoogle Scholar
  14. 14.
    Yoon JH, Lee JM, Han JK, Choi BI. Dual switching monopolar radiofrequency ablation using a separable clustered electrode: comparison with consecutive and switching monopolar modes in ex vivo bovine livers. Korean J Radiol. 2013;14(3):403–11.  https://doi.org/10.3348/kjr.2013.14.3.403.PubMedGoogle Scholar
  15. 15.
    Goldberg SN, Gazelle GS, Compton CC, Mueller PR, Tanabe KK. Treatment of intrahepatic malignancy with radiofrequency ablation: radiologic-pathologic correlation. Cancer. 2000;88(11):2452–63.  https://doi.org/10.1002/1097-0142(20000601)88:11%3c2452:AID-CNCR5%3e3.0.CO;2-3.PubMedGoogle Scholar
  16. 16.
    Lee ES, Lee JM, Kim KW, Lee IJ, Han JK, Choi BI. Evaluation of the in vivo efficiency and safety of hepatic radiofrequency ablation using a 15-G Octopus® in pig liver. Korean J Radiol. 2013;14:194–201.  https://doi.org/10.3348/kjr.2013.14.2.194.PubMedGoogle Scholar
  17. 17.
    Gao J, Wang SH, Ding XM, Sun WB, Li XL, Xin ZH, Ning CM, Guo SG. Radiofrequency ablation for single hepatocellular carcinoma 3 cm or less as first-line treatment. World J Gastroenterol. 2015;21(17):5287–94.  https://doi.org/10.3748/wjg.v21.i17.5287.PubMedGoogle Scholar
  18. 18.
    Yan K, Chen MH, Yang W, Wang YB, Gao W, Hao CY, Xing BC, Huang XF. Radiofrequency ablation of hepatocellular carcinoma: long-term outcome and prognostic factors. Eur J Radiol. 2008;67(2):336–47.  https://doi.org/10.1016/j.ejrad.2007.07.007.PubMedGoogle Scholar
  19. 19.
    Lee YH, Hsu CY, Chu CW, Liu PH, Hsia CY, Huang YH, Su CW, Chiou YY, Lin HC, Huo TI. Radiofrequency ablation is better than surgical resection in patients with hepatocellular carcinoma within the Milan criteria and preserved liver function: a retrospective study using propensity score analyses. J Clin Gastroenterol. 2015;49(3):242–9.  https://doi.org/10.1097/MCG.0000000000000133.PubMedGoogle Scholar
  20. 20.
    Solbiati L, Ahmed M, Cova L, Ierace T, Brioschi M, Goldberg SN. Small liver colorectal metastases treated with percutaneous radiofrequency ablation: local response rate and long-term survival with up to 10-year follow-up. Radiology. 2012;265(3):958–68.  https://doi.org/10.1148/radiol.12111851.PubMedGoogle Scholar
  21. 21.
    Rhim H, Lim HK, Kim YS, Choi D, Lee WJ. Radiofrequency ablation of hepatic tumors: lessons learned from 3000 procedures. J Gastroenterol Hepatol. 2008;23(10):1492–500.  https://doi.org/10.1111/j.1440-1746.2008.05550.x.PubMedGoogle Scholar
  22. 22.
    Appelbaum L, Sosna J, Pearson R, Perez S, Nissenbaum Y, Mertyna P, Libson E, Goldberg SN. Algorithm optimization for multitined radiofrequency ablation: comparative study in ex vivo and in vivo bovine liver. Radiology. 2010;254(2):430–40.  https://doi.org/10.1148/radiol.09090207.PubMedGoogle Scholar
  23. 23.
    Dupuy DE, Goldberg SN. Image-guided radiofrequency tumor ablation: challenges and opportunities–part II. J Vasc Interv Radiol. 2001;12(10):1135–48.  https://doi.org/10.1016/S1051-0443(07)61670-4.PubMedGoogle Scholar
  24. 24.
    Stippel DL, Bangard C, Prenzel K, Yavuzyasar S, Fischer JH, Hölscher AH. Which parameters are needed for targeting a multitined radiofrequency device: an approach to a simple algorithm. Langenbecks Arch Surg. 2009;394(4):671–9.  https://doi.org/10.1007/s00423-008-0306-6.PubMedGoogle Scholar
  25. 25.
    Cha J, Kim YS, Rhim H, Lim HK, Choi D, Lee MW. Radiofrequency ablation using a new type of internally cooled electrode with an adjustable active tip: an experimental study in ex vivo bovine and in vivo porcine livers. Eur J Radiol. 2011;77(3):516–21.  https://doi.org/10.1016/j.ejrad.2009.09.011.PubMedGoogle Scholar
  26. 26.
    Ni Y, Miao Y, Mulier S, Yu J, Baert AL, Marchal G. A novel “cooled-wet” electrode for radiofrequency ablation. Eur Radiol. 2000;10(5):852–4.  https://doi.org/10.1007/s003300051018.PubMedGoogle Scholar
  27. 27.
    Furse A, Miller BJ, McCann C, Kachura JR, Jewett MA, Sherar MD. Radiofrequency coil for the creation of large ablations: ex vivo and in vivo testing. J Vasc Interv Radiol. 2012;23(11):1522–8.  https://doi.org/10.1016/j.jvir.2012.08.015.PubMedGoogle Scholar
  28. 28.
    Kim JH, Won HJ, Shin YM, Kim SH, Yoon HK, Sung KB, Kim PN. Medium-sized (3.1-5.0 cm) hepatocellular carcinoma: transarterial chemoembolization plus radiofrequency ablation versus radiofrequency ablation alone. Ann Surg Oncol. 2011;18(6):1624–9.  https://doi.org/10.1245/s10434-011-1673-8.PubMedGoogle Scholar
  29. 29.
    Zhu K, Huang J, Lai L, Huang W, Cai M, Zhou J, Guo Y, Chen J. Medium or large hepatocellular carcinoma: sorafenib combined with transarterial chemoembolization and radiofrequency ablation. Radiology. 2018;288(1):300–7.  https://doi.org/10.1148/radiol.2018172028.PubMedGoogle Scholar
  30. 30.
    Yuan H, Liu F, Li X, Guan Y, Wang M. Transcatheter arterial chemoembolization combined with simultaneous DynaCT-guided radiofrequency ablation in the treatment of solitary large hepatocellular carcinoma. Radiol Med. 2018.  https://doi.org/10.1007/s11547-018-0932-1.PubMedGoogle Scholar
  31. 31.
    Francica G, Meloni MF, Riccardi L, de Sio I, Terracciano F, Caturelli E, Iadevaia MD, Amoruso A, Roselli P, Chiang J, Scaglione M, Pompili M. Ablation treatment of primary and secondary liver tumors under contrast-enhanced ultrasound guidance in field practice of interventional ultrasound centers. A multicenter study. Eur J Radiol. 2018;105:96–101.  https://doi.org/10.1016/j.ejrad.2018.05.030.PubMedGoogle Scholar
  32. 32.
    Noeren N, Nijkamp MW, Berendsen T, Govaert KM, van Kessel CS, Borel Rinkes IH, van Hillegersberg R. Multipolar radiofrequency ablation for colorectal liver metastases close to major hepatic vessels. Surgeon. 2015;13(2):77–82.  https://doi.org/10.1016/j.surge.2013.11.013.Google Scholar
  33. 33.
    Haemmerich D, Wright AW, Mahvi DM, Lee FT Jr, Webster JG. Hepatic bipolar radiofrequency ablation creates coagulation zones close to blood vessels: a finite element study. Med Biol Eng Comput. 2003;41:317e23.  https://doi.org/10.1007/BF02348437.Google Scholar
  34. 34.
    Lu DS, Raman SS, Limanond P, Aziz D, Economou J, Busuttil R, Sayre J. Influence of large peritumoral vessels on outcome of radiofrequency ablation of liver tumors. J Vasc Interv Radiol. 2003;14(10):1267–74.  https://doi.org/10.1097/01.RVI.0000092666.72261.6B.PubMedGoogle Scholar
  35. 35.
    Ahmed M, Liu Z, Afzal KS, Weeks D, Lobo SM, Kruskal JB, Lenkinski RE, Goldberg SN. Radiofrequency ablation: effect of surrounding tissue composition on coagulation necrosis in a canine tumor model. Radiology. 2004;230(3):761–7.  https://doi.org/10.1148/radiol.2303021801.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2019

Authors and Affiliations

  1. 1.Department of Ultrasound, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing)Peking University Cancer Hospital and InstituteBeijingChina

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