title: Assessment of viable tumour tissue attached to needle applicators after local ablation of liver tumours.
abstract: OBJECTIVE
  Local recurrence and needle track seeding are serious complications after local ablation for liver malignancies and potentially affect long-term survival. The aim of this study was to assess the incidence of viable tissue adherent to the needle applicators after ablation to gain insight into the possible mechanisms of local recurrence and needle track seeding.
  
  
  METHODS
  A total of 40 consecutive patients underwent 59 local liver ablations. Cells and tissue attached to the needle applicators were analysed for morphology (HE, PAP and Giemsa staining) and viability (G6PD staining).
  
  
  RESULTS
  Macroscopic tissue adherence was visible following 31 of the ablative procedures, all with radiofrequency ablation. Four applications were performed percutaneously and 27 during an open procedure. Morphologically intact tumour cells could be identified in 8 patients (20%), and viable tumour cells in 5 patients (12.5%). Morphologically intact tumour cells or viable tumour cells could only be demonstrated when track ablation was not performed.
  
  
  CONCLUSIONS
  Viable tumour cells adherent to the needle applicators were found in an alarming 12.5% of patients after local ablation. We recommend track ablation not only after the procedure but also during any shifting and (re-)positioning to prevent shedding of viable tumour cells during or after ablation.
authors.affiliation: Department of Surgery, Academic Medical Centre, Meibergdreef 9, Amsterdam, The Netherlands.
authors.forename: Nikol
authors.initials: N
authors.lastname: Snoeren
authors.forename: Maarten C
authors.initials: MC
authors.lastname: Jansen
authors.forename: Arjen M
authors.initials: AM
authors.lastname: Rijken
authors.forename: Richard
authors.initials: R
authors.lastname: van Hillegersberg
authors.forename: Gerrit
authors.initials: G
authors.lastname: Slooter
authors.forename: Joost
authors.initials: J
authors.lastname: Klaase
authors.forename: Petrousjka M
authors.initials: PM
authors.lastname: van den Tol
authors.forename: Edwin
authors.initials: E
authors.lastname: van der Linden
authors.forename: Fibo J W
authors.initials: FJ
authors.lastname: Ten Kate
authors.forename: Thomas M
authors.initials: TM
authors.lastname: van Gulik
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy*; D008297:Male; D009339:Needles / Q000009:adverse effects; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000473:pathology*; D009366:Neoplasm Seeding