A modified technique for ethanol injection of liver tumors: preliminary results.

The technique for ethanol injection of liver tumors was modified in order to obtain less reflux with a better intratumoral distribution of ethanol, leading to more extensive necrosis and to a reduction of pain. The needle was stopped just before its entrance into the tumor and ethanol was injected while the needle was advanced a little beyond the distant border of the tumor. Pain and change in echogenicity during and immediately after each injection were evaluated in 11 patients with 38 malignant lesions who received 90 injections with the new or 46 with the conventional technique. Computed tomography and biopsies were used for later follow-up. With the new technique the injected tissue volume converted much more markedly to high echogenicity (p < 0.005), the pain was significantly reduced (p < 0.001), and posttreatment biopsies significantly less often contained viable cells (p < 0.05). These preliminary results suggest that the modified injections were more effective and less painful, and have enabled us to inject a larger volume of ethanol at each session to reduce the number of treatments.