Abstract
Hepatocellular carcinoma (HCC) is increasingly diagnosed at an early, asymptomatic stage owing to surveillance of high-risk patients. Patients with early stage HCC require careful diagnostic and therapeutic management. Diagnostic confirmation of small nodules detected in cirrhotic livers may be challenging. It is very difficult to distinguish well-differentiated tumors from non-malignant hepatocellular nodules on biopsy specimens. Careful assessment of lesion vascularity – through the use of state-of-the-art dynamic imaging techniques – can provide a reliable non-invasive diagnosis. Given the complexity of the disease, multidisciplinary assessment of tumor stage, liver function and physical status is required for proper therapeutic planning. Patients with early stage HCC should be considered for any of the available curative therapies, including surgical resection, liver transplantation and percutaneous image-guided ablation. Resection is currently indicated among patients with solitary HCC and extremely well-preserved liver function, who have neither clinically significant portal hypertension nor abnormal bilirubin. Liver transplantation benefits patients who have decompensated cirrhosis and one tumor smaller than 5 cm or up to three nodules smaller than 3 cm, but donor shortage greatly limits its applicability. This difficulty might be overcome by living donation; that, however, is still at an early stage of clinical application. Image-guided percutaneous ablation is the best therapeutic choice for nonsurgical patients with early stage HCC. Although ethanol injection has been the seminal percutaneous technique, radiofrequency ablation has emerged as the most effective method for local tumor destruction and is currently used as the primary ablative modality at most institutions.
| Original language | English (US) |
|---|---|
| Title of host publication | Interventional Oncology: Principles and Practice |
| Publisher | Cambridge University Press |
| Pages | 145-159 |
| Number of pages | 15 |
| ISBN (Print) | 9780511722226, 9780521864138 |
| DOIs | |
| State | Published - Jan 1 2008 |
| Externally published | Yes |
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ASJC Scopus subject areas
- Medicine(all)
Cite this
Image-guided ablation of hepatocellular carcinoma. / Lencioni, Riccardo; Crocetti, Laura; Pina, Clotilde Della; Cioni, Dania.
Interventional Oncology: Principles and Practice. Cambridge University Press, 2008. p. 145-159.Research output: Chapter in Book/Report/Conference proceeding › Chapter
}
TY - CHAP
T1 - Image-guided ablation of hepatocellular carcinoma
AU - Lencioni, Riccardo
AU - Crocetti, Laura
AU - Pina, Clotilde Della
AU - Cioni, Dania
PY - 2008/1/1
Y1 - 2008/1/1
N2 - Hepatocellular carcinoma (HCC) is increasingly diagnosed at an early, asymptomatic stage owing to surveillance of high-risk patients. Patients with early stage HCC require careful diagnostic and therapeutic management. Diagnostic confirmation of small nodules detected in cirrhotic livers may be challenging. It is very difficult to distinguish well-differentiated tumors from non-malignant hepatocellular nodules on biopsy specimens. Careful assessment of lesion vascularity – through the use of state-of-the-art dynamic imaging techniques – can provide a reliable non-invasive diagnosis. Given the complexity of the disease, multidisciplinary assessment of tumor stage, liver function and physical status is required for proper therapeutic planning. Patients with early stage HCC should be considered for any of the available curative therapies, including surgical resection, liver transplantation and percutaneous image-guided ablation. Resection is currently indicated among patients with solitary HCC and extremely well-preserved liver function, who have neither clinically significant portal hypertension nor abnormal bilirubin. Liver transplantation benefits patients who have decompensated cirrhosis and one tumor smaller than 5 cm or up to three nodules smaller than 3 cm, but donor shortage greatly limits its applicability. This difficulty might be overcome by living donation; that, however, is still at an early stage of clinical application. Image-guided percutaneous ablation is the best therapeutic choice for nonsurgical patients with early stage HCC. Although ethanol injection has been the seminal percutaneous technique, radiofrequency ablation has emerged as the most effective method for local tumor destruction and is currently used as the primary ablative modality at most institutions.
AB - Hepatocellular carcinoma (HCC) is increasingly diagnosed at an early, asymptomatic stage owing to surveillance of high-risk patients. Patients with early stage HCC require careful diagnostic and therapeutic management. Diagnostic confirmation of small nodules detected in cirrhotic livers may be challenging. It is very difficult to distinguish well-differentiated tumors from non-malignant hepatocellular nodules on biopsy specimens. Careful assessment of lesion vascularity – through the use of state-of-the-art dynamic imaging techniques – can provide a reliable non-invasive diagnosis. Given the complexity of the disease, multidisciplinary assessment of tumor stage, liver function and physical status is required for proper therapeutic planning. Patients with early stage HCC should be considered for any of the available curative therapies, including surgical resection, liver transplantation and percutaneous image-guided ablation. Resection is currently indicated among patients with solitary HCC and extremely well-preserved liver function, who have neither clinically significant portal hypertension nor abnormal bilirubin. Liver transplantation benefits patients who have decompensated cirrhosis and one tumor smaller than 5 cm or up to three nodules smaller than 3 cm, but donor shortage greatly limits its applicability. This difficulty might be overcome by living donation; that, however, is still at an early stage of clinical application. Image-guided percutaneous ablation is the best therapeutic choice for nonsurgical patients with early stage HCC. Although ethanol injection has been the seminal percutaneous technique, radiofrequency ablation has emerged as the most effective method for local tumor destruction and is currently used as the primary ablative modality at most institutions.
UR - http://www.scopus.com/inward/record.url?scp=84932649760&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84932649760&partnerID=8YFLogxK
U2 - 10.1017/CBO9780511722226.015
DO - 10.1017/CBO9780511722226.015
M3 - Chapter
SN - 9780511722226
SN - 9780521864138
SP - 145
EP - 159
BT - Interventional Oncology: Principles and Practice
PB - Cambridge University Press
ER -