Fluoroscopy-guided Radiofrequency Ablation for Hepatocellular Carcinoma Invisible on Ultrasonography: A Retrospective Comparison with Ultrasound-guided Ablation

Abstract

Introduction: Fluoroscopy-guided radiofrequency (RF) ablation is an emerging targeting strategy for hepatocellular carcinoma (HCC) invisible on ultrasonography (US). The purposes of this study were to evaluate the technical feasibility of this technique and to compare its therapeutic efficacy with that of US-guided RF ablation. Methods: Between January 2006 and January 2012, 93 patients with 104 small HCCs (mean diameter 1.8 ± 0.5 cm) underwent percutaneous RF ablation. In 42 patients with 46 HCCs invisible on US, fluoroscopy-guided RF ablation was performed following chemoembolization (group A). The remaining 51 patients with 58 HCCs received US-guided RF ablation (group B). Technical success, technical effectiveness, complications, local tumor progression, and patients survival were retrospectively compared between the two groups. Results: Forty-five HCCs of group A became visible on fluoroscopy after chemoembolization, and RF ablation was technically successful (97.8%). Technical effectiveness was achieved in 45 HCCs of group A (97.8%) and 64 HCCs of group B (96.6%) (p = 0.65). There was no major complication in either group. The 1-, 3-, 5-year local tumor progression rates were lower in group A than those of group B with marginal significance (0%, 3.7%, and 3.7% in group A vs. 13.0%, 13.0%, and 13.0% in group B) (p = 0.05). The 1-, 3-, 5-year overall patients survival rates were 100%, 58.3%, and 51.2% (group A) and 82.4%, 54.9%, and 46.1% (group B) (p = 0.26). The 1-, 3-, 5-year recurrence-free survival rates were 68.8%, 37.5% and 25.3% (group A) and 48.7%, 27.8%, and 21.6% (group B) (p = 0.38). Conclusions: Fluoroscopy-guided RF ablation following chemoembolization is a feasible and safe therapeutic option for small HCC invisible on US. Its therapeutic effect was comparable with that of US-guided RF ablation.