Use of a novel coaxial guide needle-wire (GNW) combination system for computed tomography guided radiofrequency tumor ablation
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We developed a novel coaxial system using a fine guide needle wire (GNW) to safely and easily place the radiofrequency needle under CT-guidance. The GNW consists of a fine needle (diameter, 21-gauge; length, 150 mm) and a wire (0.018 inch, 250 mm). An exclusive radiofrequency cannula (14-gauge; 160 mm) was also used. This system was used for the treatment of six hepatocellular carcinomas in six patients. All lesions were located deeper than 10 cm from the needle entry site. This system was useful in performing CT-guided RF ablation for deeply or precariously located liver lesions particularly in patients who are unable to hold their breath.
KeywordsCompute Tomography Guidance Coaxial Needle Coaxial System Outer Needle Conventional Compute Tomography Imager
Computed tomography (CT) guided percutaneous radiofrequency (RF) tumor ablation plays an important role in the treatment of patients when lesions cannot be detected by ultrasonography. However, with CT guidance, accurate RF electrode targeting of relatively small gauge for deeply situated lesions is occasionally difficult. In particular, the weight of the RF needle makes step-by-step CT-guided angular manipulations complicated. In RF ablation, a coaxial needle system way facilitates pre-procedural planning and lesion mapping . In addition, it allows pre-treatment biopsy through the same percutaneous channel. However, it may be dangerous or difficult to puncture a lesion using a thick coaxial needle by try to trial, if the lesion is located near a vessel or the pleura [2, 3]. On this account, we supposed to believe that it may to will be safer to use two-step coaxial technique using a fine guide-needle. But two-step coaxial technique requires long guide-needle if the lesion is deeply and precariously located, and a long guide-needle is intricate to apply within the narrow CT gantry space. We developed a novel coaxial system using a fine guide needle wire (GNW) to safely and easily place the RF needle under CT-guidance.
Materials and methods
This system was used for six lesions in six patients (two men and four women; mean age, 70 years; range, 62-77) with hepatocellular carcinoma (HCC). All lesions were located deeper than 10 cm from the needle entry site (mean length, 12 cm; range, 10-15 cm). Hemocoagulation parameters in all patients were within normal limits. In addition, we used GNW for trans-hepatic drainage in deeply located abscess in one patient.
Before the therapy, an informed consent was obtained from all patients after detailed information and explanations concerning the effect and potential risks.
A conventional CT imager (X-force/SH, Toshiba Medical, Tokyo, Japan) was used for image guidance. The needle entry site and the degree of inclination needed to direct the needle into the lesion was determined by initial localization scans obtained during a metallic marker positioned on the patients' body surface.
Two-step coaxial technique is useful by for deeply situated lesions. However, this technique requires a long guide-needle (length of exceeding double of depth of lesion) and is intricate to apply within a CT gantry space.
GNW combination used in our study is easy to manipulate within a gantry space because of a short needle segment. Unlike the conventional two-step procedure, in which one first uses a guide-wire then exchanging to the outer needle, the outer needle can be steadily advanced along GNW in our new method. In our experience using the conventional two step method, the flexible wire may occasionally be pushed back to the liver surface due to resistance when intending to advance the outer needle along the wire.
Using GNW has some advantages. GNW is thinner and longer than those already available in the market today (for example, a coaxial LeVeen needle electrode; 14 gauge, 2-to 4- cm array diameter) . We support that its use is easier and safer to use than those already existing, when multiple needle manipulations are required . The light GNW also facilitated step-by-step CT-guided angular manipulations, unlike heavy RF electrodes, which are unstable during hands-free use unless deeply inserted. GNW can be applied to other interventions, such as biopsy and trans-hepatic drainage, in cases conventionally contraindicated because of high risk . The disadvantages of GNW are that the sample is very small and no statistic analysis of any kind (time, dose or number of CT images, complications etc) in comparison with results obtained with other devices .
GNW system enables us to perform safely and easily CT-guided works for deeply and precariously located lesions even in patients who are unable to hold their breath. And we suggest that GNW can be modified for trans-hepatic drainage.
This new system is useful in performing CT-guided RF ablation for deeply or precariously located liver lesions, particularly in patients who are unable to hold their breath. We, therefore propose this system for safe and efficient treatment on difficult to access lesions.
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