title: Role of B-mode ultrasound screening in detection of local tumor recurrence in the first year after radiofrequency ablation in the liver.
abstract: BACKGROUND
  Ultrasound is known to be useful in imaging radiofrequency ablation (RFA) lesions intra- and postoperatively. The presented study intends to prove the value of ultrasound examination as a means of screening RFA-treated patients for local tumor recurrence.
  
  
  METHODS
  During a period of 47 months, 91 RFA treatments were performed in 61 patients in a single institution. Indications for RFA were hepatocellular carcinoma (74%), colorectal metastases (18%), recurrent cholangiocellular carcinoma (5%) and one neuroendocrine tumor metastasis as well as one metastasis of pancreatic cancer (1.5% each). RFA was only considered in non-resectable liver cancer. All applications were conducted under sonographic guidance following preoperative evaluation. Postoperative screening included sonographic examinations at intervals of 3, 6 and 12 months postoperatively, and further annual follow-up examinations. Mean follow-up period was 11.8 months.
  
  
  RESULTS
  Within the first 12 months after treatment, the lesions become more and more inhomogenous with mixed echogeneity. Occasionally, this evolves as a misleading finding, mimicking early tumor recurrence. To clarify suspicious cases (31%), magnetic resonance imaging (20%) or computed tomography (10%) was engaged. Ultrasound led to the detection of local tumor recurrence in 78% of recurrent HCC (13 patients), but only in 67% of metastatic diseases (3 patients). Overall local recurrence rate was 18%.
  
  
  CONCLUSIONS
  Ultrasound screening as a follow-up of primary hepatic malignancies is, due to its sensitivity, capable of detecting early local recurrence despite its low specifity. Appropriate application of particular criteria of local recurrence allows B-mode ultrasound to play a major role in screening RFA-treated patients.
authors.affiliation: Department General, Visceral & Transplantation Surgery, Charité Virchow Clinic, Augustenburger Pl. 1, 13353 Berlin, Germany. robert_m.eisele@charite.de
authors.forename: Robert M
authors.initials: RM
authors.lastname: Eisele
authors.forename: Guido
authors.initials: G
authors.lastname: Schumacher
authors.forename: Enrique
authors.initials: E
authors.lastname: Lopez-Hänninen
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
mesh_terms: D017115:Catheter Ablation; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis / Q000000981:diagnostic imaging*; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography / Q000379:methods