Solid Liver Tumors Research Articles

Initial Experience With Robotic Liver Resection in the United States.

This study's aim was to show the feasibility and safety of robotic liver resection (RLR) even without extensive experience in major laparoscopic liver resection (LLR). A single center, retrospective analysis was performed for consecutive liver resections for solid liver tumors from 2014 to 2022. The analysis included 226 liver resections, comprising 127 (56.2%) open surgeries, 28 (12.4%) LLR, and 71 (31.4%) RLR. The rate of RLR increased and that of LLR decreased over time. In a comparison between propensity score matching-selected open liver resection and RLR (41:41), RLR had significantly less blood loss (384 ± 413 vs 649 ± 646mL, P = .030) and shorter hospital stay (4.4 ± 3.0 vs 6.4 ± 3.7 days, P = .010), as well as comparable operative time (289 ± 123 vs 290 ± 132 mins, P = .954). A comparison between LLR and RLR showed comparable perioperative outcomes, even with more surgeries with higher difficulty score included in RLR (5.2 ± 2.7 vs 4.3 ± 2.5, P = .147). The analysis of the learning curve in RLR demonstrated that blood loss, conversion rate, and complication rate consistently improved over time, with the case number required to achieve the learning curve appearing to be 60 cases. The findings suggest that RLR is a feasible, safe, and acceptable platform for liver resection, and that the safe implementation and dissemination of RLR can be achieved without solid experience of LLR.

Reduced-dose CT in detecting solid liver tumors: A comparison of image quality between automatic exposure control and organ effective modulation

PurposeTo evaluate the subjective and objective image quality of solid liver tumors as well as the radiation dose using organ effective modulation (OEM) technology for abdominopelvic computed tomography (CT). Material and methodsA total of 74 patients who underwent contrast-enhanced abdominopelvic CT between January and April 2022 were prospectively enrolled in this study. Patients were randomly assigned to two groups: the non-OEM group underwent CT scans with automatic exposure control (AEC), while the OEM group underwent CT scans with OEM. The radiation dose was compared between the two groups. Objective image quality was quantitatively assessed using image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). Two experienced radiologists independently evaluated the CT images (5, best; 1, worst) by four characteristics including sharpness, contrast, noise, and diagnostic confidence. ResultsThe OEM group presented a significant reduction in volume CT dose index (CTDIvol), dose-length product (DLP), and effective dose (ED) by 11.4%, 12.2%, and 12.2%, respectively (p < 0.05). There were no significant differences between two groups concerning image noise, SNR, and CNR (p > 0.05). Expect for the left and right liver lobes in portal images, OEM was slightly higher than the non-OEM (p < 0.05). The subjective scores of two radiologists demonstrated good agreement (kappa value = 0.84). No statistically significant differences were observed in subjective grading (p > 0.05). ConclusionOEM technology can effectively reduce the radiation dose of abdominopelvic-enhanced CT without affecting the subjective and objective image quality of solid liver tumors.

Case Report: Primary Liver Mature Teratoma in Childhood

We present the case of a male 2-year-old patient who underwent surgery for a 13-cm-long liver teratoma that caused elongation of the common hepatic duct and the portal vein. The boy had an abdominal mass and abdominal distension with pain of mild intensity. Abdominal computed tomography and abdominal nuclear magnetic resonance reported a predominantly cystic expansive liver lesion with some internal solid components. The case was evaluated and surgical intervention was decided, performing a right hepatectomy and biliodigestive derivation due to elongation and compromise of the common bile duct. Primary mature liver teratoma is a rare tumor in population with a higher incidence in children, so it should be suspected in all patients with solid liver tumors that do not present with high AFP values.

Magnetic-Manipulated NK Cell Proliferation and Activation Enhance Immunotherapy of Orthotopic Liver Cancer.

The immunotherapy of deep solid tumors in the human body, such as liver cancer, still faces great challenges, especially the inactivation and insufficient infiltration of immune cells in solid tumor microenvironment. Natural killer (NK) cells are gaining ever-increasing attention owing to their unique features and are expected to play an important role in the liver cancer immunotherapy. However, NK cells are severely insufficient and inactivated in solid liver tumor due to the highly immunosuppressive intratumor microenvironment, resulting in poor clinical therapeutic efficacy. Herein, we propose a mild magnetocaloric regulation approach using a magnetogenetic nanoplatform MNPs@PEI-FA/pDNA (MPFD), which is synthesized by loading a heat-inducible plasmid DNA (HSP70-IL-2-EGFP) on polyethyleneimine (PEI)- and folic acid (FA)-modified ZnCoFe2O4@ZnMnFe2O4 magnetic nanoparticles (MNPs) to promote the proliferation and activation of tumor-infiltrating NK cells under magnetic manipulation without the limitation of penetration depth for orthotopic liver cancer immunotherapy. The magnetothermally responsive MPFD serves as a magnetism-heat nanotransducer to induce the gene transcription of IL-2 cytokine in orthotopic liver tumor for NK cell proliferation and activation. Both in vitro and in vivo results demonstrate that the remote mild magnetocaloric regulation (∼40 °C) by MPFD initiates the HSP70 promoter to trigger the overexpression of IL-2 cytokine for subsequent secretion, leading to in situ expansion and activation of tumor-infiltrating NK cells through the IL-2/IL-2 receptor (IL-2R) pathways and the resulting prominent tumor inhibition. This work not only evidences the great potential of magnetogenetic nanoplatform but also reveals the underlying proliferation and activation mechanism of NK cells in liver cancer treatment by magnetogenetic nanoplatform.

Abstract 4612: Microphysiological vascularized solid liver tumor model for drug and cell therapy

Abstract Development of efficacious therapeutic strategies against solid tumors is limited by the lack of pre-clinical models that can reliably predict treatment outcomes in patients. This is primarily because models often do not accurately reflect the complexity of the tumor microenvironment (TME). The TME consists of vasculature, stromal cells and immune cells that can promote tumor resistance or prevent targeted drug and cell therapy. Here, we developed an in vitro vascularized liver tumor model in a microfluidic device to evaluate drug delivery and immunotherapy approaches. The model consists of a tumor spheroid surrounded by a perfusable self-organized vasculature bed with physiologically relevant permeability. Sorafenib (Nexavar) efficacy was evaluated by assessing tumor spheroid viability, quantified by the loss of fluorescence signal. The presence of vasculature showed enhanced cytotoxicity, highlighting the importance of tumor-vascular interactions for testing therapeutic efficacy. Engineered immune cells (chimeric antigen receptor (CAR) T-cell and transiently expressing T-cell receptors (TCR)) were introduced into the model to demonstrate immunotherapy validation. Our results showed that the engineered immune cells were more effective at infiltrating the tumor spheroid without a vasculature but were more cytotoxic in the presence of the vasculature. By removing the cultured microtissue from the device and performing digital spatial transcriptomics on standard paraffin-embedded sections, we identified known and novel genes involved in creating a pro-tumorigenic microenvironment. This platform can be utilized to model critical features of the in vivo TME, providing better predictability of drug responses, with potential applications towards personalized medicine. Citation Format: Jyothsna Vasudevan, Ragavi Vijayakumar, Jose Antonio Reales-Calderon, Maxine Sin Lam, Jin Rong Ow, Joey Aw, Damien Tan, Giulia Adriani, Andrea Pavesi. Microphysiological vascularized solid liver tumor model for drug and cell therapy. [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 1 (Regular and Invited Abstracts); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(7_Suppl):Abstract nr 4612.

Multi-Targeted Peptide-Modified Gold Nanoclusters for Treating Solid Tumors in the Liver.

Apoptosis and autophagy determine the fate of cancer cells. However, simply promoting apoptosis of tumor cells is limited in the treatment of unresectable solid liver tumors. Generally, autophagy is considered the anti-apoptotic "guardian". But the pro-apoptotic effects of autophagy can be activated by excessive endoplasmic reticulum (ER) stress. Here, amphiphilic peptide-modified glutathione (GSH)-gold nanocluster aggregates (AP1 P2 -PEG NCs)weredesigned with the enrichment of solid liver tumors and the prolonged stress in the ER, which can achieve the mutual promotion of autophagy and apoptosis in liver tumor cells. In this study, orthotopic and subcutaneous liver tumor models show the anti-tumor effectiveness of AP1 P2 -PEG NCs, with a better antitumor effect than sorafenib, biosafety (Lethal Dose, 50% (LD50 ) of 827.3mgkg-1 ), wide therapeutic window (non-toxic in 20 times of therapeutic concentration) and high stability (blood half-life of 4h). These findings identify an effective strategy to develop peptide-modified gold nanocluster aggregates with low toxicity, high potency, and selectivity for solid liver tumors treatment.

Investigation of radiomics and deep convolutional neural networks approaches for glioma grading

Purpose. To determine glioma grading by applying radiomic analysis or deep convolutional neural networks (DCNN) and to benchmark both approaches on broader validation sets. Methods. Seven public datasets were considered: (1) low-grade glioma or high-grade glioma (369 patients, BraTS’20) (2) well-differentiated liposarcoma or lipoma (115, LIPO); (3) desmoid-type fibromatosis or extremity soft-tissue sarcomas (203, Desmoid); (4) primary solid liver tumors, either malignant or benign (186, LIVER); (5) gastrointestinal stromal tumors (GISTs) or intra-abdominal gastrointestinal tumors radiologically resembling GISTs (246, GIST); (6) colorectal liver metastases (77, CRLM); and (7) lung metastases of metastatic melanoma (103, Melanoma). Radiomic analysis was performed on 464 (2016) radiomic features for the BraTS’20 (others) datasets respectively. Random forests (RF), Extreme Gradient Boosting (XGBOOST) and a voting algorithm comprising both classifiers were tested. The parameters of the classifiers were optimized using a repeated nested stratified cross-validation process. The feature importance of each classifier was computed using the Gini index or permutation feature importance. DCNN was performed on 2D axial and sagittal slices encompassing the tumor. A balanced database was created, when necessary, using smart slices selection. ResNet50, Xception, EficientNetB0, and EfficientNetB3 were transferred from the ImageNet application to the tumor classification and were fine-tuned. Five-fold stratified cross-validation was performed to evaluate the models. The classification performance of the models was measured using multiple indices including area under the receiver operating characteristic curve (AUC). Results. The best radiomic approach was based on XGBOOST for all datasets; AUC was 0.934 (BraTS’20), 0.86 (LIPO), 0.73 (LIVER), (0.844) Desmoid, 0.76 (GIST), 0.664 (CRLM), and 0.577 (Melanoma) respectively. The best DCNN was based on EfficientNetB0; AUC was 0.99 (BraTS’20), 0.982 (LIPO), 0.977 (LIVER), (0.961) Desmoid, 0.926 (GIST), 0.901 (CRLM), and 0.89 (Melanoma) respectively. Conclusion. Tumor classification can be accurately determined by adapting state-of-the-art machine learning algorithms to the medical context.

Benign solid liver tumors

Benign solid liver tumors are frequently discovered during routine sonographic examinations. As a rule, malignant tumors can be excluded using contrast medium-based sectional imaging; however, unclear cases can represent a diagnostic challenge. The category of solid benign liver tumors includes first and foremost hepatocellular adenoma (HCA), focal nodular hyperplasia (FNH) and hemangioma. Based on the most recent data, an overview of the current standards in the diagnostics and treatment is given.

Novel irreversible electroporation ablation (Nano-knife) versus radiofrequency ablation for the treatment of solid liver tumors: a comparative, randomized, multicenter clinical study.

Irreversible electroporation (IRE) is a soft tissue ablation technique that uses short electrical fields which induce the death of target cells. To evaluate the safety and efficacy of an IRE-based device compared to regular radiofrequency ablation (RFA) of solid liver tumors, in this multicenter, randomized, parallel-arm, non-inferiority study, 152 patients with malignant liver tumors were randomized into IRE (n = 78) and RFA (n = 74) groups. The primary endpoint was the success rate of tumor ablation; the secondary endpoints included the tumor ablation time, complications, tumor recurrence rates and treatment-related adverse events (TRAE). The success rate of tumor ablation using IRE was 94.9% and was non-inferior to the RFA group (96.0%) (P = 0.761). For the secondary endpoints, the average ablation time was 34.29 ± 30.38 min for the IRE group, which was significantly longer than for the RFA group (19.91 ± 16.08 min) (P < 0.001). The incidences of postoperative complications after 1 week (P = 1.000), 1 month (P = 0.610) and 3 months (P = 0.490) were not significantly different between the 2 groups. The recurrence rates of liver tumor at 1, 3 and 6 months after ablation were 0 (0.0%), 10 (13.9%) and 10 (13.3%) in the IRE group and 2.9%, 7.3% and 19.7% in the RFA control group (all P > 0.05), respectively. For safety assessments, 51 patients experienced 191 AEs (65.4%) in the IRE group, which was not different from the RFA group (73.0%, 54/184) (P = 0.646). In 7 IRE patients, 8 TRAEs (7.9%) occurred, the most common being edema of the limbs (mild grade) and fever (severe grade), while no TRAEs occurred in the RFA group. This study proved that the excellent safety and efficacy of IRE was non-inferior to the regular radiofrequency device in ablation performance for the treatment of solid liver tumors. Clinical trial registration: Chinese Clinical Trial Registry: ChiCTR1800017516

Tumor microenvironment enhanced NIR II fluorescence imaging for tumor precise surgery navigation via tetrasulfide mesoporous silica-coated Nd-based rare-earth nanocrystals.

In vivo fluorescent imaging by using the new contrast agents emitted at short-wavelength infrared region (NIR II, 1000–1700 ​nm) presents an unprecedent advantages in imaging sensitivity and spatial resolution over traditional near-infrared (NIR) light. Recently, Nd-based rare-earth nanocrystals have attracted considerable attention due to the high quantum yield (∼40%) of their emission at NIR II. However, undesirable capture by reticuloendothelial system to bring strong background signal is unsatisfying for tumor discrimination. Here, GSH-sensitive tetrasulfide bond incorporated mesoporous silica shell has entrusted onto Nd-based down-conversion nanocrystals (DCNPs) surface to totally quench the fluorescence of DCNPs. After RGD conjugation on the silica surface, the NIR II contrast agents could actively target to liver tumors. Then tetrasulfide bonds can be broken during the silica framework decomposing in cytoplasm under high GSH concentration to result in NIR II fluorescence explosive recover. Benefiting from this specific response under tumor microenvironment, the NIR II signal in other organs was markedly reduced, while the signal-to-background ratio is prominently enhanced in tumors. Then, solid liver tumors were successfully resected under the guidance of our GSH responsive NIR II fluorescent imaging with no recurrence after 20-day of surgery. Meanwhile, by combining with the ignorable side effects, the Nd-based nanoprobes vastly improved the imaging resolution of tumor margin, opening a paradigm of NIR II fluorescent imaging-guided surgery.

Drug diffusion in biomimetic hydrogels: importance for drug transport and delivery in non-vascular tumor tissue

Hydrogels of varying complexity are routinely used as scaffolds and 3D structures for in vitro tumor models to increase physiological relevance within pre-clinical cancer research. Relatively simple hydrogels such as agarose are well characterised, meanwhile biomimetic gels containing collagen and fibrin(ogen) have been studied to a much lesser extent. In this study, hydrogels mimicking the biophysical characteristics of liver cancer progression were investigated in terms of their UV-properties and influence on diffusion coefficients of different substances. UV-imaging technology was used to both visualize and quantify the diffusion process in a simple and rapid way. In general, agarose gel diffusion agreed well with predictions using the Stokes-Einstein equation meanwhile the biomimetic gels reduced diffusion coefficients by up to 70%. For doxorubicin, spatio-temporal tissue concentration modelling was used to translate in vitro diffusion to the more clinical context of tumor penetration in a solid liver tumor supplied by arterial blood.

Quantitative Automated Segmentation of Lipiodol Deposits on Cone-Beam CT Imaging Acquired during Transarterial Chemoembolization for Liver Tumors: A Deep Learning Approach

PurposeTo show that a deep learning (DL)–based, automated model for Lipiodol (Guerbet Pharmaceuticals, Paris, France) segmentation on cone-beam computed tomography (CT) after conventional transarterial chemoembolization performs closer to the “ground truth segmentation” than a conventional thresholding-based model. Materials and MethodsThis post hoc analysis included 36 patients with a diagnosis of hepatocellular carcinoma or other solid liver tumors who underwent conventional transarterial chemoembolization with an intraprocedural cone-beam CT. Semiautomatic segmentation of Lipiodol was obtained. Subsequently, a convolutional U-net model was used to output a binary mask that predicted Lipiodol deposition. A threshold value of signal intensity on cone-beam CT was used to obtain a Lipiodol mask for comparison. The dice similarity coefficient (DSC), mean squared error (MSE), center of mass (CM), and fractional volume ratios for both masks were obtained by comparing them to the ground truth (radiologist-segmented Lipiodol deposits) to obtain accuracy metrics for the 2 masks. These results were used to compare the model versus the threshold technique. ResultsFor all metrics, the U-net outperformed the threshold technique: DSC (0.65 ± 0.17 vs 0.45 ± 0.22, P < .001) and MSE (125.53 ± 107.36 vs 185.98 ± 93.82, P = .005). The difference between the CM predicted and the actual CM was 15.31 mm ± 14.63 versus 31.34 mm ± 30.24 (P < .001), with lesser distance indicating higher accuracy. The fraction of volume present ([predicted Lipiodol volume]/[ground truth Lipiodol volume]) was 1.22 ± 0.84 versus 2.58 ± 3.52 (P = .048) for the current model’s prediction and threshold technique, respectively. ConclusionsThis study showed that a DL framework could detect Lipiodol in cone-beam CT imaging and was capable of outperforming the conventionally used thresholding technique over several metrics. Further optimization will allow for more accurate, quantitative predictions of Lipiodol depositions intraprocedurally.

Liver Transplantation for Hepatic Adenomatosis: The First Case Report in Thailand and Literature Review

Hepatic adenomas are benign solid liver tumors commonly found in young females and usually asymptomatic. Hepatic adenomatosis is characterized by more than 10 adenomas in an otherwise normal liver. Bleeding and malignant transformation uncommonly occur especially in tumor larger than 5 cm and in male patients. The authors reported a case of a young female with large multiple hepatic adenomas from hepatic adenomatosis that presented with abdominal pain, large abdominal mass, weight lost, and abnormal liver function tests. She failed transarterial embolization. Surgical resection was not offered due to extent of the hepatic adenomas. She received orthotopic liver transplantation as rescue therapy. Her explanted liver showed multiple foci of hepatocellular carcinoma (HCC). Her post-operative was uneventful. The authors reported a case of liver transplantation for the treatment of unresectable hepatic adenomatosis. Keywords: Hepatic adenomatosis, Malignant transformation, Liver transplantation

Assessment of SE-MRE-derived shear stiffness at 3.0 Tesla for solid liver tumors characterization.

To evaluate the feasibility and diagnostic value of using a 2D spin-echo MR elastography (SE-MRE) sequence at 3.0 Tesla for solid focal liver lesions (FLL) characterization. This prospective study included 55 patients with solid FLL (size > 20mm), who underwent liver SE-MRE at 3 Tesla between 2016 and 2019. Stiffness measurements were performed by two independent readers blinded to the complete MRI exam or patient information. Histological confirmation or typical behavior on the complete MRI exam evaluated in consensus by expert abdominal radiologists was used as reference standard. FLLs were grouped and compared (malignant vs. benign) using the Mann-Whitney and Kruskal-Wallis tests. MRE diagnostic performance was assessed, and stiffness cutoffs were obtained by analysis of ROC curves from accuracy maximization. A linear regression plot was used to evaluate inter-rater agreement for FLLs stiffness measurements. p values < 0.05 were considered statistically significant. The final study group comprised 57 FLLs (34 malignant, 23 benign). Stiffness measurements were technically successful in 91.23% of lesions. To both readers, the median stiffness of the lesions categorized as benign was 4.5 ± 1.5kPa and in the malignant group 6.8 ± 1.7 and 7.5 ± 1.5kPa depending on the reader. A cutoff of 5.8kPa distinguished malignant and benign lesions with 88% specificity and 75-85% accuracy depending on the reader. The inter-rater agreement was 0.90 ± 0.04 with a correlation coefficient of 0.94. 2D-SE-MRE at 3.0 T provides high specificity and PPV to differentiate benign from malignant liver lesions. Trial registration 18FFUA-A02.

Current concepts in ablative procedures for primary benign liver lesions: a step forward to minimize the invasiveness of treatment when deemed necessary.

With increased use of medical imaging, the incidental detection of benign solid liver tumors has become more frequent. Facing with benign disease, the indications for surgery are still object of discussion in light of the stable natural course of most lesions and obvious drawbacks of any surgical intervention; therefore, in most situations, a conservative approach is recommended, and surgery is mainly reserved for those cases with persistent or worsening symptoms, or who are at risk for complications as malignant transformation. The advent of ablative techniques has widened the range of treatment options available to these patients, presenting as a valid alternative to resection in terms of safety and efficacy in selected cases, particularly in patients who are considered poor surgical candidates and with smaller lesions. This review outlines the role of percutaneous ablative methods for benign solid liver tumors that are encountered in adults, providing a per histology analysis of the existing evidence. The up-to-date strategies for management of the most common benign solid tumors are recapitulated.

4:03 PM Abstract No. 297 True three-dimensional holographic visualization for performance of percutaneous thermal ablation of solid liver tumors: an update on in-human evaluation

Earlier work has demonstrated bench targeting accuracy, usability, and first-in-human feasibility of an augmented-reality platform developed for 3D-HPA. The purpose of this study is to further evaluate the clinical feasibility of this novel technology. Five patients clinically indicated for microwave liver tumor ablation were enrolled in an IRB-approved protocol. Preprocedural multiphasic CT angiography (CTA) was acquired in all patients with the addition of fiducial skin markers for intraprocedural registration. 3D HPA integrates HoloLens (Microsoft, WA, USA) guidance with electromagnetic tracking of instruments to generate, register, and project holograms directly to the operative site as the instrument is navigated. Holograms are based on structures segmented from CTA (e.g., liver, vessels, tumor, bone) and a holographic light ray (HLR) co-axially extending from the tracked instrument. As standard of care, ultrasound was used for percutaneous placement of the trocar and all surgical decisions; for minimal risk to the patient at this early stage of development, holograms were only visible prior to percutaneous access and after the trocar was placed. Following ablation, images and video from postprocedural sonography, cone-beam and multidetector row CT, and HoloLens recordings were evaluated. Five patients were treated during this evaluation of 3D-HPA. In all five cases, intraprocedural holographic guidance, including HLR navigation, was in agreement with ultrasound-based guidance, as defined by (1) visualization of the guidance track relative to critical structures and (2) placement of the ablation probe within the targeted tumor. Postprocedural imaging showed adequate tumor ablation coverage. There was no recurrence at 3-month follow-up in patients who had this imaging available for review. This first clinical series further demonstrated feasibility of 3D-HPA and its potential to improve the performance of PTA, which could lead to improved quality of patient care as well as benefits for the global health care system. Further development and evaluation for tumor ablation guidance, along with other IR applications, is ongoing.

Abstract No. 480 Real-time, fused holographic visualization for performing percutaneous thermal ablation of solid liver tumors: preliminary feasibility evaluation

Abstract No. 480 Real-time, fused holographic visualization for performing percutaneous thermal ablation of solid liver tumors: preliminary feasibility evaluation

Abstract No. 506 Holographic visualization for performance of percutaneous ablation of solid liver tumors: from development, to bench testing, to first-in-human evaluation

Currently, 2D screens are used for image guidance of percutaneous ablation of solid tumors, an inherently 3D task. This can lead to inaccurate ablation probe placement which can cause inadequate treatment and subsequent tumor recurrence, among other complications. The purpose of our project was to develop and evaluate true 3D holographic guidance for PTA (“3D HPA”) from bench to first-in-human clinical evaluation, and analyze its potential to increase ablation accuracy and usability. We developed a 3D HPA prototype with our augmented-reality (AR) platform for medical applications. Holograms of the patient’s anatomy and of mini-GPS-tracked ablation probes were registered and projected directly onto the operative site with HoloLens (Microsoft, WA, USA), an untethered, head-mounted display for AR. Probe placement accuracy was first assessed on the bench by targeting 1-cm-diameter spherical simulated tumors in an anthropomorphic phantom. Next, early in vivo feasibility was evaluated in an IRB-approved clinical study while adhering to current standard of care. HoloLens video captures were recorded and reviewed from this first-in-human evaluation to analyze accuracy. During bench testing using 3D HPA, the probe tip was placed accurately within 9/9 target spheres located at depths ranging from 3 to 15 cm within the phantom. Our first attempt in vivo was also successful, as defined by placement of the ablation probe within the tumor in the location targeted by the clinician. Initial testing with our 3D HPA prototype demonstrated accurate placement of ablation probes in both phantom and in vivo settings, supporting its potential to improve accuracy of percutaneous tumor ablation, which could lead to better-quality patient care as well as potential benefits for the global health care system. Further evaluation of 3D HPA and development of applications for use of holographic visualization in other types of procedures is ongoing.

Modern methods of ablation of malignant tumors of the liver

The purpose of this review is to demonstrate the possibility of performing various methods of thermal and non-thermal ablation in patients with primary and metastatic liver tumors on the basis of data available in the world medical literature.As conservative variants of local action in patients with non-resectable primary and secondary liver tumors and inoperable patients, various ablative techniques have been developed and used to achieve local control over the disease and increase the life expectancy of this group of patients. These include: radiofrequency ablation, microwave ablation, HIFU therapy, laser ablation, cryotherapy, chemical destruction of the tumor, irreversible electroporation, stereotactic radiation therapy.The effectiveness of these ablation methods depends on the size and localization of the tumor focus, and for thermal techniques — also on its location relative to large vessels. Ablative techniques have the maximum efficiency (in some cases, similar to surgical intervention) when exposed to early forms of primary cancer or secondary tumor formation of the liver in the presence of a solitary node with a maximum size up to 5 cm or 3 and less foci size up to 3 cm. The effectiveness of local destruction of tumor formations of the liver of larger diameter is increased by carrying out ablation by the second stage after performing chemoembolization of the hepatic artery or by combining various techniques of local action.The use of various modern methods of ablation of solid primary and secondary liver tumors in medical practice can expand the possibilities of antitumor treatment of this category of patients.

Liver resection for benign solid liver tumors: patient characteristics, indications and outcomes

Liver resection for benign solid liver tumors: patient characteristics, indications and outcomes