title: Irreversible Electroporation Can Effectively Ablate Hepatocellular Carcinoma to Complete Pathologic Necrosis.
abstract: OBJECTIVE
  To describe full explant pathology and radiographic correlation in patients with hepatocellular carcinoma (HCC) treated with irreversible electroporation (IRE) who subsequently underwent liver transplant.
  
  
  METHODS
  In a retrospective study, 6 patients who had undergone IRE for HCC and subsequent orthotopic liver transplant during the period 2011-2013 were evaluated. Of the 6 patients, 4 had Child-Pugh class A cirrhosis, and 2 had class B cirrhosis. Irreversible electroporation was performed for a single focal HCC with median tumor diameter of 22 mm (range, 6-26 mm). After IRE, follow-up multiphasic cross-sectional imaging was performed at 1 month and every 3 months thereafter until liver transplant. Mean time between IRE and transplant was 10 months (range, 3-17 mo). Assessment of imaging response was based on modified Response Evaluation Criteria In Solid Tumors. Liver explants were evaluated for necrosis and viable carcinoma in IRE-treated tumors.
  
  
  RESULTS
  After IRE, all tumors showed a complete response on follow-up imaging. Five tumors showed complete pathologic necrosis without any viable carcinoma, sharply demarcated from the surrounding hepatic parenchyma. Bile ducts within the treatment area were preserved. A single tumor treated with a bipolar IRE probe had < 5% viable carcinoma cells at the periphery.
  
  
  CONCLUSIONS
  This study demonstrates the efficacy of IRE for HCC based on pathologic evaluation and correlation to radiologic findings.
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Rex G
authors.initials: RG
authors.lastname: Cheng
authors.affiliation: Department of Medicine, Division of Gastroenterology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Renuka
authors.initials: R
authors.lastname: Bhattacharya
authors.affiliation: Department of Pathology, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Yeh
authors.affiliation: Department of Radiology, Section of Interventional Radiology, University of Washington School of Medicine, Seattle, Washington.. Electronic address: spadia@uw.edu.
authors.forename: Siddharth A
authors.initials: SA
authors.lastname: Padia
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000628:therapy*; D018274:Electroporation / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy*; D008875:Middle Aged; D016896:Treatment Outcome