Utility of Contrast-Enhanced Harmonic Endoscopic Ultrasound for the Guidance and Monitoring of Endoscopic Radiofrequency Ablation
0
조회
0
다운로드
3
인용
0
참고문헌
키워드
초록
Background/Aims: Interventional endoscopists may utilize contrast-enhanced harmonic endoscopic ultrasound (CEHEUS) for image guidance during radiofrequency ablation (RFA) because of its capability to delineate real-time tumor perfusion dynamics. The purpose of this study was to assess the utility of CEH-EUS for the guidance and monitoring of endoscopic RFA. Methods: Nineteen consecutive patients with solid abdominal tumors who underwent CEH-EUS and endoscopic RFA were included. The extent of the ablation was assessed by CEH-EUS at 5 to 7 days after RFA. Additional RFAs were performed under CEH-EUS guidance. Results: The diagnoses were as follows: nonfunctioning neuroendocrine tumor (n=13), solid pseudopapillary neoplasm (SPN) (n=2), insulinoma (n=1), left adrenal adenoma (n=2), and left adrenal oligometastasis (n=1). Pre-CEH-EUS findings revealed that 17 cases showed hyperenhanced patterns and two cases of SPN showed isoenhanced patterns. CEH-EUS-assisted RFA was technically feasible in all 19 patients. After the first RFA session, seven patients of the treated tumors showed the disappearance of intratumoral enhancement on CEH-EUS, whereas 12 showed residual contrast enhancement. Twelve patients with incomplete ablation were further treated with additional RFA under real-time CEH-EUS guidance. Radiologic complete response was observed in 13 patients (68.4%). Among the 35 ablation procedures, the only adverse events were two episodes of pancreatitis (5.7%; 1 moderate and 1 mild). During the median follow-up of 28 months, the local recurrence rate was 7.7%. Conclusions: The application of CEH-EUS for RFA could be helpful in assessing early treatment response after ablation and targeting residual viable tumors during additional ablation sessions.
Abstract
Background/Aims: Interventional endoscopists may utilize contrast-enhanced harmonic endoscopic ultrasound (CEHEUS) for image guidance during radiofrequency ablation (RFA) because of its capability to delineate real-time tumor perfusion dynamics. The purpose of this study was to assess the utility of CEH-EUS for the guidance and monitoring of endoscopic RFA. Methods: Nineteen consecutive patients with solid abdominal tumors who underwent CEH-EUS and endoscopic RFA were included. The extent of the ablation was assessed by CEH-EUS at 5 to 7 days after RFA. Additional RFAs were performed under CEH-EUS guidance. Results: The diagnoses were as follows: nonfunctioning neuroendocrine tumor (n=13), solid pseudopapillary neoplasm (SPN) (n=2), insulinoma (n=1), left adrenal adenoma (n=2), and left adrenal oligometastasis (n=1). Pre-CEH-EUS findings revealed that 17 cases showed hyperenhanced patterns and two cases of SPN showed isoenhanced patterns. CEH-EUS-assisted RFA was technically feasible in all 19 patients. After the first RFA session, seven patients of the treated tumors showed the disappearance of intratumoral enhancement on CEH-EUS, whereas 12 showed residual contrast enhancement. Twelve patients with incomplete ablation were further treated with additional RFA under real-time CEH-EUS guidance. Radiologic complete response was observed in 13 patients (68.4%). Among the 35 ablation procedures, the only adverse events were two episodes of pancreatitis (5.7%; 1 moderate and 1 mild). During the median follow-up of 28 months, the local recurrence rate was 7.7%. Conclusions: The application of CEH-EUS for RFA could be helpful in assessing early treatment response after ablation and targeting residual viable tumors during additional ablation sessions.
참고문헌 (18)
- Choi JH, "Endoscopic ultrasound-guided radiofrequency ablation for management of benign solid pancreatic tumors", Endoscopy, 50, pp.1099~1104 (2018)
- 박도현, "Endoscopic Ultrasonography-Guided Ethanol Ablation for Small Pancreatic Neuroendocrine Tumors: Results of a Pilot Study", Clinical Endoscopy, 48(2), pp.158~164 (2015), 대한소화기내시경학회
- Choi JH, "Long-term outcomes after endoscopic ultrasound-guided ablation of pancreatic cysts", Endoscopy, 49, pp.866~873 (2017)
- Choi JH, "Initial human experience of endoscopic ultrasound-guided photodynamic therapy with a novel photosensitizer and a flexible laser-light catheter", Endoscopy, 47, pp.1035~1038 (2015)
- Lakhtakia S, "Endoscopic ultrasonography-guided tumor ablation", Dig Endosc, 29, pp.486~494 (2017)
- Wallace MB, "EUS 2008Working Group document: evaluation of EUS-guided tumor ablation", Gastrointest Endosc, 69(2 Suppl), pp.S59~S63 (2009)
- 최준호, "The Expanding Role of Contrast-Enhanced Endoscopic Ultrasound in Pancreatobiliary Disease", Gut and Liver, 9(6), pp.707~713 (2015), 거트앤리버 소화기연관학회협의회
- Kitano M, "New imaging techniques for endoscopic ultrasonography : contrast-enhanced endoscopic ultrasonography", Gastrointest Endosc Clin N Am, 27, pp.569~583 (2017)
- Fusaroli P, "The clinical impact of ultrasound contrast agents in EUS : a systematic review according to the levels of evidence", Gastrointest Endosc, 84, pp.587~596 (2016)
- 이태윤, "Clinical Role of Contrast-Enhanced Harmonic Endoscopic Ultrasound in Differentiating Solid Lesions of the Pancreas: A Single-Center Experience in Korea", Gut and Liver, 7(5), pp.599~604 (2013), 거트앤리버 소화기연관학회협의회
- Kitano M, "Characterization of small solid tumors in the pancreas : the value of contrast-enhanced harmonic endoscopic ultrasonography", Am J Gastroenterol, 107, pp.303~310 (2012)
- Choi JH, "Applications of contrast-enhanced harmonic endoscopic ultrasound on biliary, focal liver lesions and vascular diseases", Endosc Ultrasound, 6, pp.21~24 (2017)
- Lencioni R, "Modified RECIST(mRECIST)assessment for hepatocellular carcinoma", Semin Liver Dis, 30, pp.52~60 (2010)
- Pai M, "Endoscopic ultrasound guided radiofrequency ablation, for pancreatic cystic neoplasms and neuroendocrine tumors", World J Gastrointest Surg, 7, pp.52~59 (2015)
- Lakhtakia S, "EUS-guided radiofrequency ablation for management of pancreatic insulinoma by using a novel needle electrode(with videos)", Gastrointest Endosc, 83, pp.234~239 (2016)
- Waung JA, "Successful management of a sporadic pancreatic insulinoma by endoscopic ultrasound-guided radiofrequency ablation", Endoscopy, 48(Suppl 1), pp.E144~E145 (2016)
- Armellini E, "Endoscopic ultrasound-guided radiofrequency ablation of a pancreatic neuroendocrine tumor", Endoscopy, 47(Suppl 1 UCTN), pp.E600~E601 (2015)
- Huang DY, "Contrast-enhanced ultrasound(CEUS)in abdominal intervention", Abdom Radiol(NY), 43, pp.960~976 (2018)