Treatment response and preliminary efficacy of hepatic tumour laser ablation under the guidance of percutaneous and endoscopic ultrasonography

Abstract

Background: Studies focusing on the treatment effectiveness of endoscopic ultrasonography (EUS)-guided laser ablation (LA) for hepatic tumours or the technical differences from percutaneous ultrasonography (US)-guided LA are lacking. The objective of this study was to evaluate the treatment response and preliminary efficacy of US- and EUS-guided LA for hepatic tumours.

Methods: We performed a prospective analysis of treatment response and preliminary efficacy in 92 consecutive patients who underwent US-LA and EUS-LA from January 2015 to June 2017. The primary endpoint was complete tumour ablation (CTA). The secondary endpoint was 12-month local tumour progression (LTP).

Results: Among a total of 120 hepatic lesions, 20 lesions were ablated under the guidance of EUS. The application of the multi-fibre technique (0, 0% vs. 69, 69.0%, p < 0.01), tumours located in the left lobe (18, 90.0% vs. 28, 28.0%, p < 0.01) and multi-session ablation (4, 20.0% vs. 4, 4.0%, p = 0.009) were factors found to be significantly different between the EUS-LA and US-LA groups. The CTA was achieved in 94% of patients in the US-LA group and 100% of patients in the EUS-LA group (p = 0.261). Twelve-month LTP was observed in 8.5% of the patients in the US-LA group and 15.0% of the patients in the EUS-LA group with no significant difference between the two groups (p = 0.372). The multivariate analysis identified that the tumour diagnosis (p = 0.004; 95% CI, 0.039-0.547) was the only independent risk factor associated with 12-month LTP.

Conclusions: Patients in the EUS-LA and US-LA groups shared as similar treatment response and preliminary efficacy in the treatment of hepatic tumours. A hybrid LA approach to nonsurgical hepatic tumours appeared to be reasonable.

Keywords: Endoscopic ultrasonography; Interventional ultrasonography; Laser ablation; Liver cancer.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1

EUS-guided LA for HCC in the left external lobe of the liver is shown. In the arterial phase of the MRI, a hypo-intensity nodule located in the external lobe of the liver is hyper-enhanced (arrowhead)

Fig. 2

a In the arterial phase of contrast-enhanced EUS (26 s), an inconspicuous hypo-echoic lesion sized 1.1 × 1.2 cm is hyper-enhanced (arrowhead). b The tip of the laser fibre is clearly visualized and placed at the proximal edge of the target lesion. c The treated area is covered by a hyper-echoic zone, the range of which is approximately 2.0 × 1.7 cm in size

Fig. 3

Trans-IVC laser ablation under the guidance of EUS is shown. a A HCC lesion located at the hepatic segment VIII is detected using EUS, which was ill-defined in the percutaneous US scanning. b The lesion (white arrowheads) is located adjacent to the IVC. c A trans-IVC laser puncture is performed for the minimal nature of LA (white arrowhead: the tip of laser fibre, red arrowhead: IVC)

Fig. 4

The pre-LA and post-LA MR images of the target lesion are shown. a An arterial-phase axial MRI shows a hyper-enhanced lesion was located at the hepatic segment VIII (arrowhead). b The lesion (white arrowhead) with a high signal on T2WI is adjacent to the IVC (red arrowhead). c A portal-phase axial MRI after trans-IVC LA shows a non-enhanced ablation area (white arrowhead) with intact morphology and blood perfusion of the punctured IVC (red arrowhead)

Fig. 5

Percutaneous US-guided LA for HCC that is located adjacent to the right branch of the portal vein is shown. a An arterial-phase axial MRI shows a subcapsular hyper-enhanced lesion adjacent to the right branch of the portal vein (arrowhead). b In the arterial phase of contrast enhanced ultrasonography (CEUS) (27 s), the hypo-echoic lesion is hyper-enhanced with a diameter of 1.5 cm. c The tip of the laser fibre (yellow arrowhead) is placed to the proximal edge of the target lesion (white arrowhead). d A portal-phase axial CT after US-LA shows that the treated area is non-enhanced. The morphology of the nearby portal vein is intact with normally filled agents (arrowhead)