title: Radiofrequency and microwave ablation of subcapsular hepatocellular carcinoma accessed by direct puncture: Safety and efficacy.
abstract: OBJECTIVE
  Direct puncture of subcapsular hepatocellular carcinoma (HCC) for tumor ablation has been considered high risk due to a perceived increased incidence of hemorrhage or tumor seeding. The purpose of this retrospective multicenter study was to identify the rate of tumor seeding, hemorrhage and local tumor progression (LTP) associated with direct puncture radiofrequency (RF) and microwave (MW) ablation of subcapsular HCC.
  
  
  METHODS
  A multicenter, retrospective review of direct-puncture RF and MW performed on subcapsular HCC was conducted. Complications and local tumor progression were documented. Data was analyzed using Kaplan-Meier and log-rank tests.
  
  
  RESULTS
  The study group consisted of 60 cirrhotic patients (M/F=43/17; mean age 69.6 years) with 67 subcapsular HCC (mean diameter 2.3 cm ± 1.0 cm) that were directly punctured for RF (n=40) or MW (n=27) under ultrasound (US) guidance. The mean follow-up period was 30.8 months. There were no hemorrhagic complications. The overall LTP rate was 13.4%. There was one case of tumor tract seeding in a patient who had undergone a percutaneous biopsy two weeks prior to RF.
  
  
  CONCLUSIONS
  Thermal ablation of HCC by direct puncture appears safe and effective. There were no cases of intraperitoneal hemorrhage, and tumor seeding was seen in a single case in which a preceding percutaneous biopsy had been performed.
authors.affiliation: Department of Imaging, Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy. Electronic address: giampierofrancica@gmail.com.
authors.forename: Giampiero
authors.initials: G
authors.lastname: Francica
authors.affiliation: Department of Diagnostic Radiology, Valduce Hospital, Como, Italy.
authors.forename: Maria Franca
authors.initials: MF
authors.lastname: Meloni
authors.affiliation: Department of Internal Medicine, School of Medicine, 2nd University of Napoli, Napoli, Italy.
authors.forename: Ilario
authors.initials: I
authors.lastname: de Sio
authors.affiliation: Department of Radiology and Department of Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Medison, United States.
authors.forename: Amanda R
authors.initials: AR
authors.lastname: Smolock
authors.affiliation: Department of Radiology and Department of Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Medison, United States.
authors.forename: Christopher L
authors.initials: CL
authors.lastname: Brace
authors.affiliation: Department of Internal Medicine, School of Medicine, 2nd University of Napoli, Napoli, Italy.
authors.forename: Maddalena Diana
authors.initials: MD
authors.lastname: Iadevaia
authors.affiliation: 2nd Surgery Department, Hepato-bilio-pancreatic and digestive Surgery Unit, San Paolo Hospital, Milano, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Santambrogio
authors.affiliation: Department of Diagnostic Radiology, School of Medicine, University of Milano-Bicocca, San Gerardo Hospital, Monza, Italy.
authors.forename: Sandro
authors.initials: S
authors.lastname: Sironi
authors.affiliation: Department of Imaging, Interventional Ultrasound Unit, Pineta Grande Hospital, Castel Volturno, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Scaglione
authors.affiliation: Department of Radiology and Department of Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Medison, United States.
authors.forename: Fred T
authors.initials: FT
authors.lastname: Lee
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008872:Microwaves; D011677:Punctures; D011846:Radio Waves; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Hepatocellular carcinoma; Seeding; Thermal ablation; Ultrasound