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What is Percutaneous Ablation Therapy?

Percutaneous Ablation Therapy is a procedure that presents a minimally-invasive approach to destroying inoperable or metastasized tumors. This procedure is routinely used to treat tumors in the lung, kidney, bones and liver. It is an important treatment in the fight against small hepatocellular carcinoma (HCC) because fewer than 40% of patients are candidates for surgical treatment, and recurrence of tumors after surgery is high. Percutaneous ablation offers a local treatment option to supplement systemic therapy that has few complications and is appreciated by patients because they can often go home the same day or after an overnight hospital stay.

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The goal of ablation therapy is to destroy individual tumors that cannot be easily excised via traditional surgical methods.

Treatment is limited to the areas of the tumor, sparing the rest of the liver and reducing possible complications or side effects. MTV IR interventional radiologists focus on treatment of small (3 to 5 cm.) tumors, and small numbers of them. In the procedure, a tiny needle is inserted into the tumor, guided precisely into place by ultrasound or CT scanning.

Once the percutaneous needle is in place, destruction of the tumor is most often achieved by thermal ablation – microwave or radiofrequency – to expose cancerous tissues to high temperatures for several minutes. There are other techniques of percutaneous ablation, in which killing of the tumor is achieved by cryoablation (reducing the tumor to subzero temperatures using liquid nitrogen), or percutaneous ethanol installation (in which alcohol is injected directed into the tumor). Depending on the number of tumors being treated, a combination of these techniques may be used.


The use of percutaneous ablation is appropriate in the following cases:

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What to expect

The procedure will be performed in a hospital by interventional radiologists of MTV IR. Percutaneous ablation is most often performed under local anesthesia (to numb the insertion point for the needle) plus moderate sedation, often allowing the patient to go home the same day. In some cases, patients prefer general anesthesia, which may require an overnight hospital stay.

You should not eat or drink for six hours before the procedure.

If you prefer moderate sedation, you may experience some mild discomfort at the site where the needle is inserted or in the area being ablated. It is possible to experience some fatigue and muscle aches in the first days following the procedures, but full recovery is very fast after that.

When you arrive for your procedure, medical staff will insert an intravenous catheter into your arm to control sedation or anesthesia during the procedure. Your vital signs will be monitored and you will be taken to the CT scanner for the procedure.


Results

Results of the procedure are judged by a CT or MRI scan of the liver performed a month following the ablation. The treatment is deemed successful if all traces of the tumor have been destroyed. If this is not the case, the procedure can be safely repeated, because the advantage of percutaneous ablation is that it destroys very little surrounding liver tissue. Your progress will be monitored with CT or MRI scans at regular intervals after that to make sure there is no reoccurrence of the disease.

A Few Of Our Cases

Image A
This is an image from an MRI of the liver taken directly after we have administered a contrasting dye. You'll notice the aorta at the very bottom right is very bright and small tumor in the upper left is brighter than the surrounding area. This is often the appearance when a patient has a small Hepatocellular Carcinoma (HCC). HCC is very common in patients with cirrhosis and certain types of Hepatitis. In the US, over 40,000 new cases of HCC are diagnosed each year. Over 800,000 new cases are diagnosed world wide.
Image B
This image is taken from a CT scan of the liver after we have administered a special contrasting agent called Lipiodol. This causes the tumor to show in the CT scan as bright white. Lipiodol has a very high iodine content which stains the tumor. Different tumors take this contrasting fluid in varying degrees and the liver uptakes a small amount as well, but HCC takes it very quickly. This causes the tumor to show in the CT scan as bright white.
Image C
This CT scan shows the Microwave Ablation process. Using CT guidance, the bright white tumor is targeted with the ablation probe. The probe is inserted directly through the skin in to the tumor without cutting or surgery. The black portion inside the tumor represents gas that has formed in the tumor as the temperature in the tumor rises. The microwave probe causes the tumor to die by literally boiling the water inside the tumor without damaging any surrounding tissue.
Image D
This is an MRI scan of the liver one month after the initial procedure. In this image, contrast has been injected but the images were taken a few minutes after. The liver aorta (bottom right corner) is not as bright as that seen in image A. The liver is brighter than that in image A since the dye has been absorbed by the liver and NOT the tumor. The bright rim around the dead tumor is a normal part of the healing process. Over the course of months, the dead tumor will shrink down and become a scar.