Abstract
Objectives
Local tumour progression (LTP) is believed to be a negative consequence of imperfect thermal ablation, but we wondered if all LTP is truly due to imperfect ablation.
Methods
This study included 185 LTPs occurring within 1 cm of the ablation zone (AZ) after clinical curative thermal ablation for ≤ 5 cm hepatocellular carcinoma between 2010 and 2019. The AZ was divided into 8 quadrants by coronal, sagittal, and horizontal planes. Two methods, visual assessment through pre- and post-MRI (VA) and tumour mapping for 3D visualisation pre- and post-MRI fusion (MF), were used to assess which AZ quadrant included the shortest ablation margin (AM) by three doctors. LTP subclassification was based on whether LTP contacted the AZ margin (contacted LTP and dissociated-type LTP) and occurrence at different time points (12, 18, and 24 months).
Results
Fleiss's Kappa of VA and MF was 0.769 and 0.886, respectively. Cohen's Kappa coefficient between VA and MF was 0.830. For all LTPs, 98/185 (53.0%) occurred in the shortest AM quadrant, which showed a significant central tendency (p < 0.001). However, only 8/51 (15.7%) dissociated - type LTPs and 6/39 (15.4%) LTPs after 24 months occurred in the shortest AM quadrant, which showed no evenly distributed difference (p = 0.360 and 0.303).
Conclusions
MF is an accurate and convenient method to assess the shortest AM quadrant. LTP is a central tendency in the shortest AM quadrant, but dissociated-type and LTPs after 24 months are not, and these LTP types could be considered nonablation-related LTPs.
Key Points
• LTPs are not evenly distributed around the AZ. More than half of LTPs occur in the shortest AM quadrant.
• Subgroup analysis showed that the occurrence of contacted-type LTPs (tumour margin has direct contact with the AZ) within 24 months after ablation indeed had a high proportion in the shortest AM quadrant, and they could be called ablation-related LTPs.
• However, the dissociated-type LTPs (tumour margin adjacent to but not in contact with the AZ) or LTPs occurring beyond 24 months after ablation were evenly distributed around the AZ, and they could be called nonablation-related LTPs.
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Abbreviations
- AM:
-
Ablation Margin
- AZ:
-
Ablation Zone
- HCC:
-
Hepatocellular carcinoma
- LTP:
-
Local Tumour Progression
- MF:
-
Tumour map for 3D visualisation pre- and post-MRI fusion
- VA:
-
Visual Assessment although pre- and post-MRI
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Acknowledgements
All data generated or analysed during this study are included in this article and its supplementary material files. Further enquiries can be directed to the corresponding author.
Funding
This work was supported by Grants, 82030047, 81627803, and 91859201 from the National Scientific Foundation Committee of China, Grant JQ18021 from the National Scientific Foundation Committee of Beijing, Military Fund for Geriatric Diseases(20BJZ42), Fostering Funds for National Distinguished Young Scholar Science Fund(2018-JQPY-002) and the National Clinical Research Center for Geriatric Diseases (NCRCG-PLAGH-2019011) of Chinese PLA General Hospital.
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Guarantors of integrity of entire study, W.D., S.S.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, W.D., S.S.; clinical studies, W.D., S.S.; experimental studies, all authors; statistical analysis, W.D., S.S.; and manuscript editing, all authors.
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The scientific guarantor of this publication is Ping Liang and Jie Yu.
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• Retrospective
• Experimental
• Performed at one institution
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Ding, Wz., Liu, S., Liu, F. et al. Are all local tumour progressions of HCC related to thermal ablation? A study of the causes and classification of local tumour progression. Eur Radiol 32, 8518–8526 (2022). https://doi.org/10.1007/s00330-022-08913-1
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DOI: https://doi.org/10.1007/s00330-022-08913-1