Ultrasound-guided Ablation Research Articles

Post-surgical recurrence of hepatocellular carcinoma along resection margin treated by percutaneous US-guided ablation.

The aim of this study was to evaluate the safety and efficacy of percutaneous ablation for hepatocellular carcinoma (HCC) hepatic recurrence along surgical resection margins to achieve complete cure or bridge for additional treatment. No current recommendations exist for these lesions. Retrospective review of post-surgical recurrent HCC located along surgical margins treated by percutaneous ultrasound-guided ablation from 2006-2014. Ablation was performed by radiofrequency ablation (RFA) or percutaneous ethanol injection (PEI), selected for recurrence in proximity to extrahepatic organs. In total, nine patients (49-82 y, mean 73.8±8.3) were treated for 13 recurrent HCC nodules (9-35 mm, mean 21.5±8.1) located along resection margins by RFA (11 nodules) and PEI (2 nodules). Mean time between surgery and percutaneous ablation was 64 months (range 10-149). At a mean follow-up of 17 months (±9), complete ablation was achieved in 9 nodules (69.2%, 8 after RF, 1 after PEI) and partial ablation was achieved in 4 nodules (3 after RFA, 1 after PEI). Complications were limited to minor abdominal pain in 2 patients requiring medical therapy (15.3%). Of the 4 partially ablated nodules, subsequent therapy achieved complete response in 3 nodules (1 patient with TACE, 1 patient with stereotactic radiotherapy, and one with liver transplantation), while the last nodule progressed despite subsequent TACE. HCC recurrence along the surgical margin can be safely and effectively treated by percutaneous therapy, despite the misconception of the surgical margin as a hostile location. Percutaneous treatment may bridge the patient for additional therapy.

Endoscopic ultrasound-guided ablation of pancreatic cystic neoplasms: ready for prime time?

With the increase in the use of cross-sectional diagnostic imaging, there has been a concomitant rise in the rate of detected pancreatic cystic lesions. Recent years have seen the rise of newly developed therapeutic modalities to treat pancreatic lesions via ablation. Specifically, through the use of endoscopic ultrasound-guided therapy, endoscopists can potentially ablate these lesions safely and with minimally invasive techniques. In this manuscript we review 4 major endoscopic ultrasound-guided ablative therapies: radiofrequency ablation, ethanol injection, chemo ablation, and cryoablation. We also review the efficacy and safety of these techniques and future directions in the management of cystic pancreatic lesions.

100 Use of Seminal Plasma, Human Chorionic Gonadotropin, and Follicular Ablation on the Interval to Follicular Wave Emergency and Dominant Follicle in Alpacas (Vicugna pacos)

Alpacas, as other camelids, are inducer ovulators and FIO/NGF-β, a protein present in the seminal plasma (SP) is reported as the responsible of the ovulation (Kershaw-Young et al. 2012 Reprod. Fertil. Dev. 24, 1093-1097, 10.1071/RD12039). However, limited and controversial information exists regarding characteristics of follicular wave in alpacas post-induction of ovulation with SP or other stimulus. The experiment was designed to determine the effect of 3 external stimulations on the interval to follicular wave emergence and the interval to dominant follicle. Adult female alpacas between 5 and 6 years old were assigned to 1 of 3 treatments: (1) SP (n = 6): 1 mL of SP IM; (2) hCG (n = 5): 1000 IU of hCG (Pregnyl, Organon-Holland, Amsterdam, the Netherlands), via IM; or (3) follicular ablation (FA, n = 6): animals were induced by ultrasound-guided ablation of the dominant follicle ≥7 mm. Alpacas from treatments 1 and 2 were examined by ultrasonography (Aloka SSD 500, transducer 7.5 MHz; Aloka, Tokyo, Japan) at 1- to 2-h intervals between 22 and 30 h after treatment or until ovulation occurred, whichever occurred first. All animals were evaluated by ultrasonography every day from Day 2 to Day 7 post-treatment and after that on Days 9, 12, and 15 post-treatment. Data from one alpaca (FA group) was excluded because of problems in the timing of ablation. Therefore, the total number of alpaca used was 16 (SP = 6, hCG = 5, and FA = 5). Results of the effect in external stimulation were analysed using ANOVA. In conclusion, interval to the emergence of a new follicular wave on the detection of follicles ≥3 mm and interval to dominant follicle ≥7 mm differed for FA compared with hCG but not compared with SP treatment. Table 1.Follicular wave emergence (mean ± SEM) under 3 external stimulations: seminal plasma (SP), hCG, or follicular ablation (FA)

Radiofrequency Thermal Ablation Heat Energy Transfer in an Ex-Vivo Model

Little work has been done to consider the temperature changes and energy transfer that occur in the tissue outside the vein with ultrasound-guided vein ablation therapy. In this experiment, a Ex-Vivo model of the human calf was used to analyze heat transfer and energy degradation in tissue surrounding the vein during endovascular radiofrequency ablation (RFA). A clinical vein ablation protocol was used to determine the tissue temperature distribution in 10 per cent agar gel. Heat energy from the radiofrequency catheter was measured for 140 seconds at fixed points by four thermometer probes placed equidistant radially at 0.0025, 0.005, and 0.01 m away from the RFA catheter. The temperature rose 1.5°C at 0.0025 m, 0.6°C at 0.005 m, and 0.0°C at 0.01 m from the RFA catheter. There was a clinically insignificant heat transfer at the distances evaluated, 1.4 ± 0.2 J/s at 0.0025 m, 0.7 ± 0.3 J/s at 0.0050 m, and 0.3 ± 0.0 J/s at 0.01 m. Heat degradation occurred rapidly: 4.5 ± 0.5 J (at 0.0025 m), 4.0 ± 1.6 J (at 0.0050 m), and 3.9 ± 3.6 J (at 0.01 m). Tumescent anesthesia injected one centimeter around the vein would act as a heat sink to absorb the energy transferred outside the vein to minimize tissue and nerve damage and will help phlebologists strategize options for minimizing damage.

499 - Safety Profile of Uterine Myoma Treatment Using Noninvasive Robotic Ultrasound-Guided Shell Ablation

Study Objective: To assess the safety profile of uterine myoma treatment using a noninvasive robotic ultrasound-guided ablation device that combines thermal and ischemic necrosis to minimize treatment time.

Long-term outcomes after endoscopic ultrasound-guided ablation of pancreatic cysts

Background and study aims The aim of this study was to investigate the long-term outcomes after endoscopic ultrasound (EUS)-guided pancreatic cyst ablation. Patients and methods In a single-center, prospective study, 164 patients with pancreatic cysts underwent EUS-guided cyst ablation using ethanol with paclitaxel. The inclusion criteria were as follows: unilocular or oligolocular cysts; clinically indeterminate cysts that required EUS fine-needle aspiration; and/or cysts that grew during the observation period. Treatment response was classified as complete resolution, partial resolution, or persistent cyst, with < 5 %, 5 % - 25 %, and 25 % of the original cyst volume, respectively. Results The median largest diameter of the cyst was 32 mm and the median volume was 17.1 mL. Based on cyst fluid analysis there were 71 mucinous cystic neoplasms, 16 serous cystic neoplasms, 11 intraductal papillary mucinous neoplasms, 3 pseudocysts, and 63 indeterminate cysts. Sixteen treated patients (9.8 %) had adverse events (1 severe, 4 moderate, and 11 mild). Treatment response was as follows: complete resolution in 114 (72.2 %), partial resolution in 31 (19.6 %), and persistent cysts in 13 (8.2 %). Twelve of the 13 patients with persistent cysts underwent surgery. During clinical and imaging follow-up (median 72 months, interquartile range 50 - 85 months) of the 114 patients with complete resolution, only two patients (1.7 %) showed cyst recurrence. Based on multivariate analysis, the absence of septa (odds ratio [OR] 7.12, 95 % confidence interval [CI] 2.72 - 18.67) and cyst size less than 35 mm (OR 2.39, 95 %CI 1.11 - 5.16) predicted complete resolution. Conclusion Among patients with pancreatic cysts in whom complete resolution was achieved after EUS-guided cyst ablation, 98.3 % remained in remission at 6-year follow-up. Unilocular form and small cyst size were predictive of complete resolution. This treatment approach may be an effective and durable alternative to surgery.Trial registered at ClinicalTrials.gov (NCT 00689715).

Clinical impact of cone beam computed tomography on iterative treatment planning during ultrasound-guided percutaneous ablation of liver malignancies.

A standardized cone beam computed tomography (CBCT) protocol may impact optimal ablation probe(s) positioning during ultrasound-guided microwave ablation (MWA). To evaluate this hypothesis, 15 patients underwent ultrasound-guided percutaneous MWA of 15 liver lesions (10 hepatocellular carcinomas, 5 metastasis ranging 11-41mm) with the ultrasound guidance assisted by a dedicated CBCT protocol. Pre-procedural enhanced CBCT (ceCBCT) was performed after intravenous contrast administration to visualize the lesion and determine the optimal approach using CBCT-based ablation planning software. MW antennas were positioned under ultrasound guidance, and non-enhanced CBCT was performed after deployment and fused with pre-procedural ceCBCT to assess tumor targeting and modify subsequent steps of the procedure. CBCT lesion detection accuracy and number of needle repositioning on the basis of CBCT information were recorded. Clinical success was measured on 1-month follow-up contrast-enhanced CT. The target lesion was detected on ceCBCT in 13 out of 15 patients (87%). The undetected lesions were only visible on diagnostic contrast-enhanced magnetic resonance imaging, which was then fused to the CBCT and fluoroscopy to facilitate targeting. MW antennas were repositioned on the basis of CBCT in 11 lesions (73%). Clinical success was achieved in 14/15 ablations (93%) with a mean follow-up of X months. The only case of local recurrence was expected, as the intent was tumor debulking. CBCT imaging during ultrasound-guided liver ablation is feasible and leads to ablation device repositioning in the majority of cases.

Nursing of patients who use ultrasound-guided thermal ablation to treat severe secondary hyperparathyroidism

Objective To summary the nursing methods of patients who use ultrasound-guided thermal ablation to treat severe secondary hyperparathyroidism. Methods Retrospective analysis was used to analyze the nursing process of 10 patients who use ultrasound-guided thermal ablation to treat severe secondary hyperparathyroidism. Ultrasound-guided thermal ablation was applied to patients with significant cardiopulmonary dysfunction and cannot undergo general anaesthesia operation, and patients suffering from recurrent forearm grafting after parathyroidectomy. So, in the nursing of these patients, we should pay special attention to the observation and management of specific complications in thermal ablation including dyspnea, apnea, laryngeal and recurrent laryngeal nerve injury and hemorrhage, besides the routine psychological care, diet nursing and medication nursing. Results Ten patients in the study who underwent ultrasound-guided thermal ablation, the intact serum parathyroid hormone (intact parathyroid hormone, iPTH), calcium and phosphorus were all decreased, and symptoms like itching, general bone pain also were released. The frequency of precordial pain was reduced and we gain good therapeutic effect. Conclusions Rigorous nursing after ultrasound-guided thermal ablation can promote the recovery of patients with severe secondary hyperparathyroidism. Key words: Hyperparathyroidism, secondary; Nursing; Thermal ablation

Gaining Proficiency with New Technology: Ten Surgeons’ Early Experience with Laparoscopic Ultrasound-Guided Radiofrequency Volumetric Thermal Ablation of Uterine Myomas (RFVTA, the Acessa™ Procedure)

Gaining Proficiency with New Technology: Ten Surgeons’ Early Experience with Laparoscopic Ultrasound-Guided Radiofrequency Volumetric Thermal Ablation of Uterine Myomas (RFVTA, the Acessa™ Procedure)

Úspěšná sklerotizace adenomu příštítného tělíska absolutním alkoholem u devadesátiletého seniora

Úspěšná sklerotizace adenomu příštítného tělíska absolutním alkoholem u devadesátiletého seniora

Biliary complications after percutaneous ablation for patients with hepatic malignant tumors: retrospective analysis of ultrasonic imaging features and clinical outcomes

Objective To retrospectively analyze the ultrasonic imaging features and clinical outcomes of biliary complications after percutaneous ablation for hepatic malignant tumors. Methods The cli-nical data of patients with postablation biliary complications who underwent percutaneous ablation for hepatic malignant tumors in the past 7 years in our department were retrospectively analyzed. The ultrasonic imaging features and the clinical outcomes of biliary complications on follow-up of these patients were analyzed. Results Postablation biliary complications occurred in 65 patients, including 34 patients with bile duct dilatation and 31 patients with biloma. In patients with bile duct dilatation, the dilated bile ducts were located distal to the ablation lesions in all these patients. Among 30 patients with bile duct dilatation, the dilatation was progressive in 9 patients (9/30, 30.0%) and stable in 20 patients (20/30, 66.7%), while in one patient (1/30, 3.3%) it resolved on follow-up. The radiologic features of bilomas mainly manifested as four types: crescent, interspersed, circumferential and solitary nodular, and the number of patients with the four types were 13 (13/31, 41.9%), 13(13/31, 41.9%), 3(3/31, 9.7%) and 2(2/31, 6.5%), respectively. In 6 patients (6/31, 19.4%) the bilomas were subjected to interventional or surgical therapy while for the remaining 25 patients (6/31, 19.4%) they were treated conservatively. Three (3/25, 12.0%) of the latter 25 patients had spontaneously disappearance of the biloma and 2 (2/25, 8.0%) of the remaining 22 patients appeared to have progressive increase in size. In 17 (17/25, 68.0%) patients the biloma remained stable in size and in the remaining 3 patients (3/25, 12.0%) the bilomas resolved. Conclusions Postablation biliary complications of ultrasound-guided percutaneous ablation for hepatic malignant tumors mainly presented as biloma and bile duct dilatation. Dilated bile ducts were located in the distal side of the ablation zones. Crescent type and interspersed type were the most common morphological types of biloma. Although most patients with postablation biliary complications of ultrasound-guided percutaneous ablation remained stable or resolved on follow-up, interventional or surgical therapy was necessary in the minority of patients. Key words: Hepatic malignant tumors; Percutaneous ablation; Biliary complication

Su1276 Sonographic and Cyst Fluid Cytological Changes Following the Endoscopic Ultrasound-Guided Pancreatic Cyst Ablation

Su1276 Sonographic and Cyst Fluid Cytological Changes Following the Endoscopic Ultrasound-Guided Pancreatic Cyst Ablation

Endoscopic ultrasound-guided ablation of branch-duct intraductal papillary mucinous neoplasms: Feasibility and safety tests using porcine gallbladders.

Radiofrequency ablation (RFA) and ethanol ablation are accepted methods of tissue destruction for treating cystic tumors. The aim of the present study was to evaluate the feasibility, efficacy, and safety of endoscopic ultrasound (EUS)-guided ablation using normal porcine gallbladders as a substitute model for branch-duct intraductal papillary mucinous neoplasms (BD-IPMN). Six adult mini pigs were included in this prospective study. EUS-guided RFA with or without ethanol ablation of the gallbladder was carried out using a prototype 18-gauge endoscopic RFA electrode, and RFA and ethanol ablation were done in a single session. Outcomes were assessed in terms of macroscopic and microscopic evaluations of the treated gallbladders. The prototype RFA electrode was used for ablation of the mucosa, aspiration of the internal contents of the gallbladder, and ethanol injection. RFA plus ethanol lavage resulted in a greater mean percentage of denuded gallbladder mucosa (97.5%) than RFA alone (55.8%). Effects of ablation extending to the cystic duct and partially denuded cystic duct mucosae were detected in five of the six pigs. There were no major procedure-related adverse events. EUS-guided ablation of the gallbladder mucosa was feasible and effective in the porcine model. Additional studies will be required to fully assess the risk of procedure-related damage to the main pancreatic duct before using this technique in a clinical setting.

Ultrasound-guided Ethanol Ablation: Where does It fit in the Treatment of Recurrent Metastatic Papillary Thyroid Cancer?

ABSTRACT Introduction Ethanol (ETOH) ablation of metastatic neck nodes has been described as a potentially safe and effective alternative to surgical excision. We sought to describe a subset of these patients well suited for ETOH ablation. Materials and methods We report ultrasound-guided ETOH ablation of metastatic papillary thyroid cancer (PTC) at a Tertiary Care Endocrine Surgery Unit over 5 years. A retrospective review of all reoperative lymph node dissections was undertaken. Ethanol injection was used as second-line treatment to operative excision and was standardized with ultrasound guidance and the use of 1 cc/cm3 of 100% ETOH solution. Results Five treatments of ultrasound-guided ETOH ablation were studied. All patients had been previously treated with radioactive iodine (RAI) (mean: 1.25 treatments of 174mCi), however, in three cases with pretreatment I-131 scan, no uptake of radioiodine was seen in the treated disease. In four cases with pretreatment fludeoxyglucose-positron emission tomography (FDG-PET), treated lesions were avid. Median follow-up time for treatment was 28.5 months, with no disease progression in all ablated lesions. Serum thyroglobulin (Tg) values in patients without Tg-antibody were lower after treatment. There were no complications. Conclusion Surgeons seeking a less-invasive approach for nodal metastases in the neck can consider ETOH ablation. Small ultrasound detectable lesions in scarred necks (irradiated and/or reoperative) which are radioiodine non-avid and FDG-PET avid may be best suited for this treatment. As demonstrated by a small set of patients in a Tertiary Care Endocrine Surgery Unit, ETOH ablation is safe and effective at controlling progression of targeted local disease. How to cite this article Pasternak JD, Kluijfhout W, Seiser N, Gosnell JE, Suh I, Duh Q-Y, Shen WT. Ultrasound-guided Ethanol Ablation: Where does It fit in the Treatment of Recurrent Metastatic Papillary Thyroid Cancer? World J Endoc Surg 2016;8(3):199-202.

122 TIMED ARTIFICIAL INSEMINATION IN WOOD BISON USING FROZEN-THAWED SEMEN

Recent progress with methods to control ovulation and semen cryopreservation in Wood Bison was the impetus to test the feasibility of timed AI to facilitate reclamation of this threatened species. A 2 × 2 design was used to compare the efficacy of 2 ovulation synchronization techniques and 2 semen cryopreservation protocols. Female Wood Bison were assigned randomly to 2 groups (n = 24/group) in which ovarian synchronization was induced by ultrasound-guided ablation of follicles &gt;5 mm or intramuscular treatment with 2.5 mg of estradiol 17B + 50 mg of progesterone (E+P) in canola oil. A progesterone-releasing intravaginal device (PRID) was placed at the time of follicle ablation (for 5 days) or E+P treatment (for 8 days) in the respective groups. A luteolytic dose of prostaglandin was given at the time of PRID removal, and 2500 IU of hCG was given IM 3 days later. Bison were inseminated 24 and 36 h after hCG treatment using frozen-thawed semen. The semen was collected by electro-ejaculation from 4 Wood Bison bulls, pooled, and divided into aliquots diluted in either egg-yolk extender (EY) or cholesterol-loaded cyclodextrin extender (CLC). Half the bison in each synchronization group were inseminated with either EY- or CLC-extended semen. Bison were examined by ultrasonography every 12 h beginning on the day of hCG treatment for 3 days or until ovulation was detected, whichever occurred first. Pregnancy diagnosis was made by ultrasonography 34–36 days after insemination. Two bison were excluded during the experiment because of handling difficulty; therefore, the total number of bison used was 46. Ovulation rate and interval to ovulation were compared between synchronization groups by chi-square and t-test, respectively. Pregnancy rates were compared among groups by 2-way ANOVA after transforming data to arcsin. The ovulation rate was not different between synchronization groups [combined mean, 37/46 (80%)], nor was the degree of synchrony, as assessed by the residuals (variation from the mean) in the respective groups. However, the diameter (mean ± standard error of the mean) of the dominant follicle at the time of hCG treatment was smaller in the follicle ablation group than in the E+P group (10.5 ± 0.6 v. 13.9 ± 0.6; P &lt; 0.04), and the interval from hCG treatment to ovulation tended to be longer (35.3 ± 1.6 v. 31.8 ± 1.3 h; P ≤ 0.10). Pregnancy rate was not affected by synchronization procedure, but pregnancy was detected only in the EY-inseminated group (9/23 v. 0/23; P &lt; 0.01). Despite that post-thaw sperm motility was similar for EY and CLC semen (41.7 ± 2.9 and 44.6 ± 3.3%; respectively), CLC-treated semen failed to impregnate bison in vivo. We concluded that synchronization and timed insemination with frozen-thawed semen is feasible in Wood Bison. Of the 23 bison inseminated with EY-extended semen, 21 ovulated (91%), and of those that ovulated 9 became pregnant (43%). Both synchronization schemes were effective, but the ablation protocol may be improved by an additional day between ablation and hCG treatment. We thank Vetoquinol Canada and Merck Animal Health for providing hormone treatments.

Clinical significance of preoperative platelet-to-lymphocyte ratio in recurrent hepatocellular carcinoma after thermal ablation: A retrospective analysis

Purpose: The aim of this study was to elucidate the clinical significance of preoperative Platelet-to-lymphocyte ratio (PLR) in recurrent hepatocellular carcinoma (RHCC) patients after thermal ablation.Materials and methods: We retrospectively reviewed 414 patients with RHCC treated with ultrasound-guided thermal ablation percutaneously between January 2010 and March 2014. The correlation of recurrence-free survival (RFS) with 15 clinical parameters was analysed by Cox multivariate proportional hazard model analysis. The best cut-off value of preoperative PLR was determined with time-dependent receiver operating characteristic (ROC) curve analysis. The value of PLR in predicting recurrence was analysed by Kaplan-Meier.Results: Multivariate Cox proportional hazard model analysis showed that tumour differentiation, prothrombin time (PT), absolute lymphocyte count (ALC) and PLR were risk factors for recurrence in RHCC patients. PLR ≥ 87.87 was considered for evaluation (AUROC = 0.667; P < 0.05), and 166 of 414 patients (40.1%) had PLR of more than 87.87. During the follow-up period (12–52 months), the 1- and 3-year recurrence rates were 39.9% and 54.8% in the low PLR group, which were significantly better than those in the high PLR group (56.0% and 79.5%) (P < 0.05). Kaplan-Meier analysis demonstrated that the RFS in the low PLR group was 45.2% which was significantly higher than that of the high PLR group (20.5%) (X2 = 24.019, P < 0.05). This result suggested that preoperative PLR is a predictor for recurrence followed thermal ablation in RHCC patients, and patients with PLR ≥ 87.87 indicated higher RFS, which may improve the clinical management of RHCC patients. Further studies are warranted to validated this finding and test its clinical applicability in RHCC.

Abstract B95: Is ethanol required for cyst ablation in patients with premalignant type pancreatic cysts?

Abstract Background: Mucinous pancreatic cystic lesions have the propensity to progress into pancreatic cancer. Currently radiographic surveillance or surgical resection is recommended for this premalignant type of cyst, both of which have significant limitations. Recently, endoscopic ultrasound-guided cyst ablation has emerged as an innovative and promising alternative treatment approach. Previous studies have shown that EUS-guided ethanol lavage of pancreatic cysts is safe and results in complete cyst resolution in 1/3 of patients. Subsequent studies demonstrated marked increases in rates of ablation with infusion of paclitaxel following ethanol lavage, which raises the question of whether alcohol is necessary for effective ablation. This is important, since ethanol extravasation is felt to have caused two complications in previous trials, abdominal pain and pancreatitis. This study hypothesizes that the removal of alcohol lavage prior to chemotherapy infusion will not impair ablation rates and will decrease complication rates. A secondary aim of this study is to assess whether a custom chemoablation cocktail tailored to pancreatic neoplasia (paclitaxel+gemcitabine) will improve ablation rates overall. Gemcitabine was chosen because it dilutes paclitaxel for injection and has been the standard in pancreatic cancer chemotherapy. Recently, the combination of paclitaxel and gemcitabine was shown to improve response rates and progression-free survival when compared with gemcitabine alone. Methods: Patients with mucinous or indeterminate type pancreatic cysts of 1-5cm’s without signs of malignancy were randomized to undergo either EUS-guided lavage with 80% alcohol or normal saline followed by infusion of 3 mg/ml paclitaxel + 19mg/ml gemcitabine (both arms). 9 patients were enrolled in this initial pilot study and evaluated post op, at 72 hours, with two week lab tests and by CT scan at 3, 6, and 12 months to assess response rates and for any complications. Results: The initial 9 patients of this trial (expected to have an N of 78 when complete) were randomized for this pilot study with 8 patients then able to be treated. Pancreatic cysts ranged in maximum diameter from 2.2cm to 3.8 cm (mean 2.9 cm). Location included body (n=4), head (n=2), neck (n=1) and tail (n=1). The overall reduction in cyst surface area was 67% at 3 months and 82% at 6 months. At 6 months size reduction was 81% in the alcohol infusion arm and 83% in the alcohol-free arm. Complications were mild abdominal pain (1) in the alcohol free arm (12.5%), moderate abdominal pain (1), and mild pancreatitis (1) in the alcohol arm (25%). Conclusion: The treatment of mucinous type pancreatic cysts with either alcohol or saline lavage followed by gemicitabine-paclitaxel infusion is feasible and safe in this limited pilot study. Initial results indicate that alcohol-free ablation does not impair ablation efficacy and is associated with fewer complications although the full sample size will be required to prove this hypothesis with any certainty. Citation Format: Matthew T. Moyer, Setareh Sharzehi, Charles E. Dye, Wafik El-Deiry, Thomas J. McGarrity, Abraham Mathew, Niraj Gusani, Raquel E. Davila, Brooke Ancrile. Is ethanol required for cyst ablation in patients with premalignant type pancreatic cysts? [abstract]. In: Proceedings of the AACR Special Conference on Pancreatic Cancer: Innovations in Research and Treatment; May 18-21, 2014; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2015;75(13 Suppl):Abstract nr B95.

Fluoroscopy-guided radiofrequency ablation for small hepatocellular carcinoma: a retrospective comparison with ultrasound-guided ablation

To compare the therapeutic efficacy of fluoroscopy-guided radiofrequency ablation (F-RFA) and ultrasound-guided RFA (US-RFA) in treatment of small hepatocellular carcinoma (HCC). Between January 2006 and January 2012, 93 patients with small HCCs underwent percutaneous RFA. In 42 patients with 46 HCCs invisible on US, F-RFA was performed following intra-arterial iodised oil injection (group A). The remaining 51 patients with 58 HCCs received US-RFA (group B). Technical effectiveness, complications, local tumour progression, and patient survival were retrospectively compared between the two groups. Technical effectiveness was achieved in 45 HCCs of group A (97.8%) and 64 HCCs of group B (96.6%; p=0.65). There was no major complication in either group. The 1-, 3-, and 5-year local tumour progression rates were lower in group A than those of group B with marginal significance (0%, 3.7% and 3.7% in group A, and 13%, 13%, and 13% in group B; p=0.05). The 1-, 3-, and 5-year patient survival rates were 100%, 58.3%, and 51.2% (group A), and 82.4%, 54.9%, and 46.1% (group B; p=0.26). F-RFA is a feasible and safe treatment for small HCC invisible on US. Its therapeutic efficacy was comparable with that of US-RFA.

Interventional Musculoskeletal Ultrasound

Rather than try and perform a comprehensive review of ultrasound-guided musculoskeletal intervention, this article is arranged to focus on specific topics by revisiting and discussing the practical ways of improving the commonly performed procedures including the treatment of De Quervain’s tenosynovitis and calcific tendinopathy in addition to addressing recent and newly developed procedures such as platelet-rich protein and ultrasound-guided nerve ablation.

Abstract #1260: Outcomes, Side Effects and Risk Factors for Complications of Ultrasound-Guided Laser Ablation for Thyroid Nodules. A Multicenter Study on 1531 Patients

Abstract #1260: Outcomes, Side Effects and Risk Factors for Complications of Ultrasound-Guided Laser Ablation for Thyroid Nodules. A Multicenter Study on 1531 Patients