Korean J Radiol.  2008 Feb;9(1):29-37. 10.3348/kjr.2008.9.1.29.

Sonography Guided Percutaneous Radiofrequency Ablation of Hepatocellular Carcinoma: Effect of Cooperative Training on the Pretreatment Assessment of the Operation's Feasibility

• Kim MJ
• Lim HK
• Choi D
• Lee WJ
• Rhim HC
• Kim S

• KMID: 1734272
• DOI: http://doi.org/10.3348/kjr.2008.9.1.29

Abstract

OBJECTIVE
The aim of this study is to investigate the effects of cooperative training on the pretreatment assessment of the feasibility to perform Ultrasonography (US) guided percutaneous radiofrequency ablation for patients afflicted with hepatocellular carcinoma. MATERIALS AND METHODS: In our prospective study, 146 patients with 200 hepatocellular carcinomas were referred for radiofrequency ablation after triage by hepatologists. Three radiologists with different levels of experience performed the planning US before (group I) and after (group II) cooperative training, to evaluate whether radiofrequency ablation was feasible. The feasibility rates considered eligible according to our criteria were evaluated. In addition, we analyzed the reasons for the lack of feasibility were analyzed. The interobserver agreement for the assessment of feasibility before and after training was also calculated. RESULTS: The overall feasibility rates for both groups was 73%. No significant difference in the feasibility rates was observed. The feasibility rates of each observer for group I were 71% (observer 1), 77% (observer 2) and 70% (observer 3) and those for group II were 73%, 76% and 69%, respectively. In the tumors (n = 164) considered ineligible, the two most common causes for refraining from performing radiofrequency ablation included non-visualization of the tumor (62%) and the absence of a safe route for the percutaneous approach (38%). We found moderate interobserver agreement for all observers before cooperative training and a good agreement after training. CONCLUSION: Although the cooperative training did not affect the feasibility rate of each observer, it improved the interobserver agreement for assessing the feasibility of performing US guided radiofrequency ablation, which may reduce unnecessary admission or delayed treatment.

Keyword

Liver neoplasm, US; Therapeutic radiology, pretreatment planning

MeSH Terms

Adult
Aged
Aged, 80 and over
Carcinoma, Hepatocellular/*surgery/ultrasonography
*Catheter Ablation
Clinical Competence
Feasibility Studies
Humans
Inservice Training
Liver Neoplasms/*surgery/ultrasonography
Male
Middle Aged
Prospective Studies
Reproducibility of Results
*Ultrasonography, Interventional

Figure

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  Fig. 1 The histogram shows the feasibility rates assessed by the three observers with different levels of experience to perform radiofrequency ablation in liver tumors. No statistical difference in feasibility rates between the two groups before and after cooperative training was observed (GEE test, p>0.05).

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  Fig. 2 56-year-old man with small hepatocellular carcinoma. A. Contrast-enhanced transverse CT scan obtained during the hepatic arterial phase shows a 2.0 cm diameter hepatocellular carcinoma (arrow) in liver segment 8. B-D. Pretreatment planning sonographic scans performed by three different observers show an echogenic mass (arrows) in same corresponding area of liver. All three observers judged that the US guided percutaneous radiofrequency ablation was feasible for this tumor.

• 

  Fig. 3 58-year-old man with two small hepatocellular carcinomas. A. Contrast-enhanced transverse CT scan obtained during hepatic arterial phase shows a 1.5 cm diameter enhancing tumor (arrowhead) in liver segment 8 and another 1.8 cm in diameter tumor (arrow) in liver segment 7. B. Pretreatment planning sonographic scans performed by observer 1 shows tumor (arrow) in liver segment 7 with poor conspicuity. The tumor of segment 8 was not visible. In addition to non-visualization of tumors, there was no safe path for the electrode due to the intervening lung base. All three observers considered that US guided percutaneous ablation was not feasible for these tumors.

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  Fig. 4 Discrepancy in assessing feasibility of US guided percutaneous radiofrequency ablation in a 45-year-old man with hepatocellular carcinoma. A. Contrast-enhanced transverse CT scan obtained during hepatic arterial phase shows a 3.5 cm diameter enhancing tumor (arrow) in liver segment 8. B-D. On the pretreatment planning sonographic scans performed by observer 1 (B), observer 2 (C), and observer 3 (D), the tumor (arrows) is well delineated as hypoechoic mass. Observer 1 considered that US guided percutaneous radiofrequency ablation was not feasible because of absence of a safe path resulting from the position of the hepatic vein (arrowheads) in B surrounding the tumor. The other two observers thought that the procedure was feasible.

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