title: Seeding from hepatocellular carcinoma after percutaneous ablation: color Doppler ultrasound findings.
abstract: BACKGROUND
  We describe the clinical and color Doppler ultrasound findings in a series of cases of seeding from hepatocellular carcinoma (HCC) observed in patients treated with percutaneous ablation therapy (PAT) over a 15-year period.
  
  
  METHODS
  We reviewed the clinical and imaging records of 12 patients with cirrhosis (nine men and three women, age range 51-82 years, mean age 63 years) that showed neoplastic seeding from HCC occurring after one or more PAT procedures. Five of 12 cases of seeding were observed as a complication of 1080 PAT procedures (0.46%) performed in 545 patients (0.96%) by two of the authors (L.T., G.F.) over a long period (15 years) at different institutions. The other seven patients had been treated with PAT procedures at other institutions and had come to our attention during post-treatment follow-up.
  
  
  RESULTS
  The 12 patients who had seeding nodules had undergone the following PAT procedures: multisession conventional percutaneous ethanol injection (PEI) without anesthesia (four patients), single-session PEI with general anesthesia (three patients), single-session PEI with general anesthesia plus multisession conventional PEI (four patients), and single-session PEI plus radiofrequency ablation (one patient). Seeding nodules ranged from 0.9 to 6.0 cm (mean 1.7 cm). Eleven of 12 seeding nodules appeared as hypervascular hypoechoic nodules with smooth and regular margins and multiple intralesional vascular signals.
  
  
  CONCLUSIONS
  Clinical and imaging findings of seeding from HCC should be recognized by physicians who perform follow-up ultrasound examinations of patients who are treated with PAT. Early diagnosis of seeding can be reliably made by scanning the abdominal wall with small probes in the area where the previous PAT has been performed. Hypoechoic hypervascular pattern of the seeding nodule allows definitive diagnosis.
authors.affiliation: Interventional Ultrasound Unit, Department Of Medicine, S. Giovanni Di Dio Hospital Aslna 3, Via Mario Vergara Padre, 187, 80027 Frattamaggiore, Naples, Italy. luciano_tarantino@fastwebnet.it
authors.forename: L
authors.initials: L
authors.lastname: Tarantino
authors.forename: G
authors.initials: G
authors.lastname: Francica
authors.forename: F
authors.initials: F
authors.lastname: Esposito
authors.forename: D
authors.initials: D
authors.lastname: Pisaniello
authors.forename: D
authors.initials: D
authors.lastname: Parmeggiani
authors.forename: G
authors.initials: G
authors.lastname: Marzullo
authors.forename: I M F
authors.initials: IM
authors.lastname: Sordelli
authors.forename: P
authors.initials: P
authors.lastname: Sperlongano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009366:Neoplasm Seeding; D011184:Postoperative Period; D012189:Retrospective Studies; D018615:Ultrasonography, Doppler, Color