title: Percutaneous cryoablation of small hepatocellular carcinomas using a 17-gauge ultrathin probe.
abstract: OBJECTIVE
  To evaluate the feasibility and safety of percutaneous cryoablation (PCA) of small hepatocellular carcinomas (HCCs) using a 17 G ultrathin cryoprobe.
  
  
  METHODS
  Twenty patients (male:female ratio14:6) with 20 HCCs, who were not surgical candidates, underwent ultrasound (US)-guided PCA for treatment of HCCs. Single HCCs less than 3cm in diameter were included in this study. Ablation was performed using a 17 G cryoprobe. The effectiveness was determined by the changes in alpha-foetoprotein level and degree of tumour necrosis on follow-up computed tomography (CT); complete response (100% necrosis), partial response (100%>necrosis≥30%), stable disease (any cases not qualifying for either partial response or progressive disease) and progressive disease (increase of at least 20% in diameter of viable tumour). Haemoglobin, white blood cell count (WBC), serum glutamic oxaloacetic transaminase (SGOT), serum glutamic pyruvic transaminase (SGPT), and total bilirubin were compared before and after the procedure, and the technical feasibility, complications, clinical outcomes and survival of each patient were also evaluated.
  
  
  RESULTS
  All procedures were technically successful. Each patient complained of negligible pain and there was no other procedure-related complication or mortality. The mean level of alpha-foetoprotein declined significantly from 53.2 to 20.4ng/ml 1 month after the procedure (p<0.05). At 1-month follow-up CT, there were 13 complete responses, four partial responses, three patients with stable disease, and no patients had progressive disease. Six of seven lesions that did not present with a complete response underwent further treatment. On long-term follow up (6-30 months; mean 20.7), a local recurrence was seen in one of 13 lesions (8%) with complete response revealed. Laboratory findings showed no significant changes except for the transient increase of SGOT and SGPT.
  
  
  CONCLUSIONS
  US-guided PCA using a 17 G cryoprobe was feasible and safe for the treatment of HCC smaller than 3cm.
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Gangnam Severance Hospital, 712 Eonjuro, Gangnam-gu, Seoul 135-720, Korea.
authors.forename: S M
authors.initials: SM
authors.lastname: Lee
authors.forename: J Y
authors.initials: JY
authors.lastname: Won
authors.forename: D Y
authors.initials: DY
authors.lastname: Lee
authors.forename: K-H
authors.initials: KH
authors.lastname: Lee
authors.forename: K S
authors.initials: KS
authors.lastname: Lee
authors.forename: Y H
authors.initials: YH
authors.lastname: Paik
authors.forename: J K
authors.initials: JK
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003452:Cryosurgery / Q000295:instrumentation* / Q000379:methods; D018450:Disease Progression; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D011446:Prospective Studies; D013523:Surgical Equipment; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome