title: Histopathologic comparison of monopolar versus no-touch multipolar radiofrequency ablation to treat hepatocellular carcinoma within Milan criteria.
abstract: OBJECTIVE
  To compare histopathologically the completeness of radiofrequency (RF) ablation to treat hepatocellular carcinoma (HCC) with monopolar or multipolar technique.
  
  
  METHODS
  Thirty-five consecutive patients (mean age, 59 y) with cirrhosis and HCC (n = 59) within Milan criteria received RF ablation and subsequently underwent liver transplantation (LT) for tumor progression or liver failure. Data were extracted retrospectively from a prospective database. Thirty nodules were treated with a monopolar device with internally cooled (n = 17) or perfused (n = 13) electrodes, and 29 were treated with a multipolar technique with internally cooled electrodes based on the "no-touch" concept. This consisted of inserting two or three straight electrodes around the nodule to avoid intratumor puncture to the greatest extent possible. Effectiveness of the three devices was compared by histopathologic examination of explants. Fisher exact and χ(2) tests and multivariate logistic regression analysis were performed.
  
  
  RESULTS
  Mean sizes of nodules ablated (25, 22, and 21.6 mm) and median times from ablation to LT (11, 7.5, and 8.4 months) for patients treated with the monopolar internally cooled electrode device (MoICD), monopolar perfused electrode device (MoPED), and multipolar internally cooled electrode device (MuICD), respectively, were similar (P = .8 and P = .9, respectively). Pathologic examination showed complete necrosis for eight of 17 and six of 13 nodules treated with the MoICD and MoPED, respectively, versus 26 of 29 treated with the MuICD (P = .0019). In multivariate analysis, RF technique remained the predictive factor for complete necrosis (P = .005).
  
  
  CONCLUSIONS
  Ablation of small HCCs with multipolar RF ablation based on the no-touch concept improves the rate of complete necrosis during pathologic examination compared with monopolar techniques.
authors: Radiology Service (O.S., Y.R., N.S.); Formation and Research Unit of Health, Medicine and Human Biology (O.S., Y.R., P.N., J.C.T., M.B., N.S.), Sorbonne Paris Cité, Université Paris 13, Bobigny. Electronic address: olivier.seror@jvr.aphp.fr.
authors: Olivier
authors: O
authors: Seror
authors: Hepatogastroenterology Service (G.N., P.N., J.C.T., M.B.), Assistance-Publique Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Centre Hospitalo-Universitaire Jean Verdier, Bondy.
authors: Gisèle
authors: G
authors: N'Kontchou
authors: Department of Pathology (J.T.V.N.).
authors: Jeanne Tran
authors: JT
authors: Van Nhieu
authors: Radiology Service (O.S., Y.R., N.S.); Formation and Research Unit of Health, Medicine and Human Biology (O.S., Y.R., P.N., J.C.T., M.B., N.S.), Sorbonne Paris Cité, Université Paris 13, Bobigny.
authors: Yacine
authors: Y
authors: Rabahi
authors: Hepatogastroenterology Service (G.N., P.N., J.C.T., M.B.), Assistance-Publique Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Centre Hospitalo-Universitaire Jean Verdier, Bondy; Formation and Research Unit of Health, Medicine and Human Biology (O.S., Y.R., P.N., J.C.T., M.B., N.S.), Sorbonne Paris Cité, Université Paris 13, Bobigny.
authors: Pierre
authors: P
authors: Nahon
authors: Visceral Surgery Service (A.L., D.C.), Assistance-Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Centre Hospitalo-Universitaire Henri Mondor, Créteil.
authors: Alexis
authors: A
authors: Laurent
authors: Hepatogastroenterology Service (G.N., P.N., J.C.T., M.B.), Assistance-Publique Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Centre Hospitalo-Universitaire Jean Verdier, Bondy; Formation and Research Unit of Health, Medicine and Human Biology (O.S., Y.R., P.N., J.C.T., M.B., N.S.), Sorbonne Paris Cité, Université Paris 13, Bobigny.
authors: Jean Claude
authors: JC
authors: Trinchet
authors: Visceral Surgery Service (A.L., D.C.), Assistance-Publique Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Centre Hospitalo-Universitaire Henri Mondor, Créteil.
authors: Daniel
authors: D
authors: Cherqui
authors: Department of Clinical Research (E.V.), Assistance-Publique Hôpitaux de Paris, Groupe Hospitalo-Universitaire Saint Louis-Lariboisière-Fernand Widal, Hôpital Fernand Widal, Paris, France.
authors: Eric
authors: E
authors: Vicaut
authors: Hepatogastroenterology Service (G.N., P.N., J.C.T., M.B.), Assistance-Publique Hôpitaux de Paris, Hôpitaux Universitaires Paris Saint-Denis, Centre Hospitalo-Universitaire Jean Verdier, Bondy; Formation and Research Unit of Health, Medicine and Human Biology (O.S., Y.R., P.N., J.C.T., M.B., N.S.), Sorbonne Paris Cité, Université Paris 13, Bobigny.
authors: Michel
authors: M
authors: Beaugrand
authors: Radiology Service (O.S., Y.R., N.S.); Formation and Research Unit of Health, Medicine and Human Biology (O.S., Y.R., P.N., J.C.T., M.B., N.S.), Sorbonne Paris Cité, Université Paris 13, Bobigny.
authors: Nicolas
authors: N
authors: Sellier
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D016009:Chi-Square Distribution; D004867:Equipment Design; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery*; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009336:Necrosis; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D047368:Tumor Burden