Liver tumor gross margin identification and ablation monitoring during liver radiofrequency treatment.
OBJECTIVE
To determine whether tissue visible light spectroscopy (VLS) used during radiofrequency (RF) ablation of liver tumors could aid in detecting when tissue becomes adequately ablated, locate grossly ablated regions long after temperature and hydration measures would no longer be reliable, and differentiate tumor from normal hepatic tissue based on VLS spectral characteristics.


METHODS
Studies were performed on human liver in vivo and animal liver ex vivo. In three ex vivo cow livers, RF-induced lesions were created at 80 degrees C. A 28-gauge needle embedded with VLS optical fibers was inserted alongside an RF ablation array, and tissue spectral characteristics were recorded throughout ablation. In one anesthetized sheep in vivo, a VLS needle probe was passed through freshly ablated liver lesions, and ablated region spectral characteristics were recorded during probe transit. In two human subjects, a VLS needle probe was passed through liver tumors in patients undergoing hepatic tumor resection without ablation, and tumor spectral characteristics were recorded during probe transit.


RESULTS
In bovine studies, there was significant change in baseline absorbance (P < .0001) as a result of increased light scattering as liver was ablated. Liver exhibited native differential absorbance peaks at 550 nm that disappeared during ablation, suggesting that optical spectroscopy detects markers of tissue altered during ablation. In sheep, liver gross ablation margins were clearly defined with millimeter resolution during needle transit through the region, suggesting that VLS is sensitive to gross margins of ablation, even after the temperature has normalized. In humans, absorbance decreased as the needle passed from normal tissue into tumor and normalized after emerging from the tumor, suggesting that absence of native liver pigment may serve as a marker for the gross margins and presence of tumors of extrahepatic origin.


CONCLUSIONS
In human subjects, VLS during RF liver tumor ablation depicted gross hepatic tumor margins in real time; in animal subjects, VLS achieved monitoring of when and where RF ablation endpoints were achieved, even long after the tissue cooled. Real-time in vivo monitoring and treatment feedback may be possible with the use of real-time VLS sensors placed along side of, or embedded into, the RF probe, which can then be used as an adjunct to standard imaging during tumor localization and RF ablation treatment.
Hsu
Christopher P
CP
Santa Clara Valley Medical Center, San Jose, California, USA.
Razavi
Mahmood K
MK
So
Samuel K
SK
Parachikov
Ilian H
IH
Benaron
David A
DA
D000230:Adenocarcinoma / Q000556:secondary; D000368:Aged; D000818:Animals; D001831:Body Temperature; D017115:Catheter Ablation; D002417:Cattle; D015179:Colorectal Neoplasms / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D016343:Monitoring, Intraoperative; D009339:Needles; D000078702:Radiofrequency Therapy; D013057:Spectrum Analysis / Q000295:instrumentation; D047368:Tumor Burden