Rhode Island Medical Imaging, Rhode Island Hospital, Brown University, Providence, RI, USA.
Karmanos Cancer Institute, 110 East Warren, Hudson-Weber Building, Suite 504, Detroit, MI, 48201, USA.
Abdom Radiol (NY). 2016 Apr;41(4):767-80. doi: 10.1007/s00261-016-0687-x.
To report our long-term experience with percutaneous cryotherapy for primary and metastatic liver tumors, including historical perspectives on complications over time and local recurrence rates.
Following IRB approval under HIPAA compliance, 342 CT fluoroscopic-guided, percutaneous cryotherapy procedures were performed for 443 masses in 212 outpatients with hepatocellular carcinoma (HCC; N = 36), or metastatic disease (N = 176), grouped as colorectal carcinoma (CRC) and non-CRC metastases. Tumor and ablation sizes were noted in relation to adjacent vasculature. All complications were graded according to standardized criteria. Patients were followed by CT and/or MRI at 1, 3, 6, 12, 18, 24 months and yearly thereafter. Local recurrences were defined as either "procedural" within the ice ablation zone, or "satellite" within 1 cm of the ablation rim to evaluate recurrence patterns.
Average tumor diameter of 2.8 cm was treated by average cryoprobe number of 4.5, which produced CT-visible ice ablation zone diameters averaging 5.2 cm. Grade >3 complications were primarily hematologic [N = 20/342; (5.8%)], and appeared related to pre-procedural anemia/thrombocytopenia, carcinoid tumor type, and large ablation volumes. No significant central biliary leak, strictures, or bilomas were noted. At a mean follow-up of 1.8 years, local tumor recurrences were 5.5%, 11.1%, and 9.4% for HCC, CRC, and non-CRC metastases, respectively, consisting mainly of satellite foci. No significant difference was noted for local recurrences near major blood vessels or tumors >3 cm diameter.
Percutaneous hepatic cryotherapy is a well-visualized, safe procedure that produces very low local recurrence rates, even for tumors near vasculature and diameters over 3 cm. Cryoablation deserves to be in the armamentarium of percutaneous hepatic ablation, especially with careful patient selection for tumors <4 cm and patients with platelet counts >100,000. Percutaneous hepatic cryoablation represents a highly flexible technique with particular benefits near central biliary structures and/or adjacent crucial structures.
报告我们在原发性和转移性肝脏肿瘤的经皮冷冻治疗方面的长期经验，包括随着时间的推移对并发症的历史观察和局部复发率。
在符合 HIPAA 规定的 IRB 批准下，对 212 名门诊患者的 443 个肿块进行了 342 次 CT 透视引导下的经皮冷冻治疗，这些患者患有肝细胞癌（HCC；N=36）或转移性疾病（N=176），分为结直肠癌（CRC）和非 CRC 转移。记录肿瘤和消融的大小与邻近血管的关系。所有并发症均根据标准化标准进行分级。通过 CT 和/或 MRI 在 1、3、6、12、18、24 个月和此后每年进行随访。局部复发定义为冰消融区域内的“手术”或消融边缘 1cm 内的“卫星”，以评估复发模式。
平均肿瘤直径为 2.8cm，平均使用 4.5 个冷冻探针进行治疗，产生的 CT 可见冰消融区域直径平均为 5.2cm。>3 级并发症主要是血液学方面的[N=20/342；（5.8%）]，与术前贫血/血小板减少、类癌肿瘤类型和大的消融体积有关。未发现明显的中央胆管漏、狭窄或胆汁瘤。在平均 1.8 年的随访中，HCC、CRC 和非 CRC 转移的局部肿瘤复发率分别为 5.5%、11.1%和 9.4%，主要为卫星灶。在靠近大血管或直径>3cm 的肿瘤附近，局部复发无显著差异。
经皮肝脏冷冻治疗是一种可视化效果好、安全的方法，即使对于靠近血管和直径超过 3cm 的肿瘤，也能产生非常低的局部复发率。冷冻消融术值得成为经皮肝脏消融的手段之一，特别是对于肿瘤<4cm 和血小板计数>100,000 的患者进行仔细的患者选择。经皮肝脏冷冻消融术是一种非常灵活的技术，在靠近中央胆管结构和/或邻近关键结构时具有特殊的优势。
