Percutaneous ultrasound-guided radiofrequency ablation with artificial pleural effusion for hepatocellular carcinoma in the hepatic dome.

Abstract

Nodules of hepatocellular carcinoma (HCC) located in the hepatic dome cannot be depicted on ultrasography because of pulmonary air. Therefore, percutaneous treatment is not possible in such cases. The purpose of this study was to clarify the feasibility and safety of percutaneous sonographically guided radiofrequency (RF) ablation with the concurrent use of artificial pleural effusion for HCC located in the right subphrenic region. Between May 2001 and June 2002, 24 patients with 28 HCC nodules located directly below the diaphragm were enrolled in this study. The patient population included 17 men and 7 women (age range, 51-87 years; mean age, 66.5 years). The maximum diameter of the HCC nodules ranged from 1.0 cm to 4 cm (mean +/- SD, 2.1 +/- 0.8 cm). We infused 200-1100 ml of 5% glucose solution intrathoracically to separate the lung and liver; thus, obtaining an image of the whole tumor was impossible on gray-scale sonography. Complete tumor necrosis was achieved in a single session of RF ablation in 27 (96.4%) of the 28 lesions, while two sessions of RF ablation were required for the remaining lesion (3.6%). During treatment, no dyspnea or other complications concerned with the respiratory system were observed. Clinical courses have been satisfactory without recurrences at 1-13 months after treatment (mean, 7.9 months). Percutaneous RF ablation with artificial pleural effusion in patients with HCC in the hepatic dome may be a safe and feasible therapy.