Seeding risk following percutaneous approach to hepatocellular carcinoma

[Guest guest]

Liver Transplantation

Volume 13, Issue 11 , Pages 1603 - 1607

Published Online: 29 Oct 2007

Liver Transplantation Worldwide

Seeding risk following percutaneous approach to hepatocellular carcinoma

D. Perkins, M.D.

Liver Transplantation Worldwide, University of Washington Medical Center,

Seattle, WA

Abstract

Background

Tumour biopsy is usually considered mandatory for patient management by

oncologists. Currently percutaneous ablation is used therapeutically for

cirrhotic patients with small hepatocellular carcinoma (HCC), not suitable for

resection or waiting for liver transplantation. However malignant seeding is a

recognized complication of both diagnostic and therapeutic procedures in

patients with HCC. Although percutaneous therapy whether with or without biopsy

of a suspected HCC nodule may minimize the risk of seeding, this has not been

confirmed.

Aim

To evaluate the risk of seeding, defined as new neoplastic disease occurring

outside the liver capsule, either in the subcutaneous tissue or peritoneal

cavity following needle biopsy and/or local ablation therapy (LAT).

Methods

A literature search resulted in 179 events in 99 articles between January 1983

and February 2007: 66 seedings followed liver biopsy, 26 percutaneous ethanol

injection (PEI), 1 microwave, 22 radiofrequency ablation (RFA), and 64 after

combined biopsy and percutaneous treatment (5 microwave; 33 PEI; 26 RFA).

Results

In 41 papers specifying the total number of patients biopsied and/or treated,

the median risk of seeding was 2.29% (range 0-11%) for biopsy group; 1.4%

(1.15-1.85%) for PEI when used with biopsy and 0.61% (0-5.56%) for RFA without

biopsy, 0.95% (0-12.5%) for RFA with biopsy and 0.72% (0-10%) for liver nodules

(including non-HCC nodules) biopsied and ablated.

Conclusion

Risk of seeding with HCC is substantial and appears greater with using

diagnostic biopsy alone compared to therapeutic percutaneous procedures. This

risk is particularly relevant for patients being considered for liver

transplantation.

http://www3.interscience.wiley.com/cgi-bin/abstract/116836564/ABSTRACT

_________________________________________________________________

You keep typing, we keep giving. Download Messenger and join the i’m Initiative

now.

http://im.live.com/messenger/im/home/?source=TAGLM

[Guest guest]

Liver Transplantation

Volume 13, Issue 11 , Pages 1603 - 1607

Published Online: 29 Oct 2007

Liver Transplantation Worldwide

Seeding risk following percutaneous approach to hepatocellular carcinoma

D. Perkins, M.D.

Liver Transplantation Worldwide, University of Washington Medical Center,

Seattle, WA

Abstract

Background

Tumour biopsy is usually considered mandatory for patient management by

oncologists. Currently percutaneous ablation is used therapeutically for

cirrhotic patients with small hepatocellular carcinoma (HCC), not suitable for

resection or waiting for liver transplantation. However malignant seeding is a

recognized complication of both diagnostic and therapeutic procedures in

patients with HCC. Although percutaneous therapy whether with or without biopsy

of a suspected HCC nodule may minimize the risk of seeding, this has not been

confirmed.

Aim

To evaluate the risk of seeding, defined as new neoplastic disease occurring

outside the liver capsule, either in the subcutaneous tissue or peritoneal

cavity following needle biopsy and/or local ablation therapy (LAT).

Methods

A literature search resulted in 179 events in 99 articles between January 1983

and February 2007: 66 seedings followed liver biopsy, 26 percutaneous ethanol

injection (PEI), 1 microwave, 22 radiofrequency ablation (RFA), and 64 after

combined biopsy and percutaneous treatment (5 microwave; 33 PEI; 26 RFA).

Results

In 41 papers specifying the total number of patients biopsied and/or treated,

the median risk of seeding was 2.29% (range 0-11%) for biopsy group; 1.4%

(1.15-1.85%) for PEI when used with biopsy and 0.61% (0-5.56%) for RFA without

biopsy, 0.95% (0-12.5%) for RFA with biopsy and 0.72% (0-10%) for liver nodules

(including non-HCC nodules) biopsied and ablated.

Conclusion

Risk of seeding with HCC is substantial and appears greater with using

diagnostic biopsy alone compared to therapeutic percutaneous procedures. This

risk is particularly relevant for patients being considered for liver

transplantation.

http://www3.interscience.wiley.com/cgi-bin/abstract/116836564/ABSTRACT

_________________________________________________________________

You keep typing, we keep giving. Download Messenger and join the i’m Initiative

now.

http://im.live.com/messenger/im/home/?source=TAGLM