Advances in US-Guide RFA

Abstract

Radiofrequency ablation (RFA) is accepted as nonsurgical curative treatment option for early stage HCC in most treatment guidelines. Furthermore, RFA is recommended even as the first line treatment for very early stage HCC. Accurate targeting (Placement of electrode) is one of essential step for successful ablation. Among various guiding modalities, ultrasound is the most popular modality due to its unique advantages. As the tumor size detected on State of Art Liver MRI is getting smaller, the conspicuity of tumor becomes more challenging. Technical advance in ultrasound including fusion imaging and contrast enhanced ultrasound (especially Sonazoid) contribute to more sophisticated procedure for the inconspicuous tumor. For a tumor with unfavorable location, artificial ascites will improve sonic window as well as prevent thermal injury to the adjacent organ. For a larger tumor, multiple RF electrodes or new energy source (microwave) will be getting more popular in Asian countries. Despites several sustained challenges in US-guided tumor ablation for HCC, the indication are continuously expanding for the tumor with poor conspicuity, the tumor with unfavorable location, and the larger tumor. Local ablative therapy will provide a definite role in HCC management as a curative as well as adjuvant modality along with currently advance of US technologies.