Background: The aim of this retrospective study was to compare the feasibility and efficiency of ultrasound-guided percutaneous microwave ablation (US-PMWA) assisted by three-dimensional visualization ablation planning system (3DVAPS) and conventional 2D planning for hepatocellular carcinoma (HCC) (diameter > 3 cm). Methods: One hundred thirty patients with 223 HCC nodules (5.0 ± 1.5 cm in diameter, [3.0–10.0 cm]) who met the eligibility criteria divided into 3D and 2D planning group were reviewed from April 2015 to August 2018. Ablation parameters and oncological outcomes were compared, including overall survival (OS), recurrence-free survival (RFS), and local tumor progression (LTP). Multivariate analysis was performed on clinicopathological variables to identify the risk factors for OS and LTP. Results: The median follow-up period was 21 months (range 3–44). Insertion number (5.4 ± 1.2 VS. 4.5 ± 0.9, P = 0.034), ablation time (1249.2 ± 654.2 s VS. 1082.4 ± 584.7 s, P = 0.048), ablation energy (57,000 ± 11,892 J VS. 42,600 ± 10,271 J, P = 0.038) and success rate of first ablation (95.0% VS. 85.7%, P = 0.033) were higher in the 3D planning group compared with those in 2D planning group. There was no statistical difference in OS, and RFS between the two groups (P = 0.995, P = 0.845). LTP rate of 3D planning group was less than that of 2D planning group (16.5% VS 41.2%, P = 0.003). Multivariate analysis showed tumor maximal diameters (P < 0.001), tumor number (P = 0.003) and preoperative TACE (P < 0.001) were predictors for OS and sessions (P = 0.024), a-fetoprotein level (P = 0.004), and preoperative planning (P = 0.002) were predictors for LTP, respectively. Conclusions: 3DVAPS improves precision of US guided ablation resulting in lower LTP and higher 5 mm-AM for patients with HCC lesions larger than 3 cm in diameter.

Background: Researches comparing laparoscopic liver resection (LLR) with microwave ablation (MWA) for 3–5 cm multifocal hepatocellular carcinoma (MFHCC) are rare. Materials and methods: From 2008 to 2019, 666 intrahepatic tumours in 289 patients from 12 tertiary medical centres in China were included in this retrospective study. Propensity score matching (PSM) was performed to balance variables between the two treatment groups over time frames 2008–2019 and 2013–2019 to observe the potential impact of advancements in intervention techniques on overall survival (OS), disease-free progression (DFS) of patients. complications, hospitalization, and cost were compared. Results: Among 289 patients, the median age was 59 years [interquartile range (IQR) 52–66]. 2008–2019, after PSM, the median OS was 97.4 months in the LLR group and 75.2 months (95% CI 47.8–102.6) in the MWA group during a follow-up period of 39.0 months. The 1-year, 3-year and 5-year OS rates in the two groups were 91.8%, 72.6%, 60.7% and 96.5%, 72.8%, 62.5% [hazard ratio (HR) 1.03, 95% CI 0.62–1.69, P =0.920]; The corresponding DFS rates were 75.9%, 57.2%, 46.9%, and 53.1%, 17.5%, 6.2% (HR 0.35, 95% CI 0.23–0.54, P 0.05). MWA had shorter intervention times, hospitalization, and lower costs. Conclusions: For resectable MFHCC patients, LLR is preferable due to its lower recurrence rate. For patients who do not qualify for LLR, advances in ablation technology have promoted MWA as a promising alternative.

Objective . Radiation therapy requires a precise target location. However, respiratory motion increases the uncertainties of the target location. Accurate and robust tracking is significant for improving operation accuracy. Approach . In this work, we propose a tracking framework Multi3, including a multi-templates Siamese network, multi-peaks detection and multi-features refinement, for target tracking in ultrasound sequences. Specifically, we use two templates to provide the location and deformation of the target for robust tracking. Multi-peaks detection is applied to extend the set of potential target locations, and multi-features refinement is designed to select an appropriate location as the tracking result by quality assessment. Main results . The proposed Multi3 is evaluated on a public dataset, i.e. MICCAI 2015 challenge on liver ultrasound tracking (CLUST), and our clinical dataset provided by the Chinese People’s Liberation Army General Hospital. Experimental results show that Multi3 achieves accurate and robust tracking in ultrasound sequences (0.75 ± 0.62 mm and 0.51 ± 0.32 mm tracking errors in two datasets). Significance . The proposed Multi3 is the most robust method on the CLUST 2D benchmark set, exhibiting potential in clinical practice.

To evaluate the value of a three dimension (3D)visualization operative planning system in ultrasound-guided percutaneous microwave ablation (US-PMWA) for large hepatic hemangiomas (LHHs). Fifty-eight patients with LHHs were divided into 3D and 2D groups. The therapeutic efficacy was assessed by contrast-enhanced imaging during follow-up. Hepatic and renal function were examined. The complete ablation, tumor volume shrinkage, and complication rates were analyzed. The ablation time and energy of the 3D group were lower than those of the 2D group (1152.0 ± 403.9 s vs. 1379.7 ± 375.8 s and 87,407.2.9 ± 50,387.0 J vs. 117,775.8 ± 46,245.6 J, P = 0.031 and 0.021, respectively). The 3D group had a higher complete ablation rate than the 2D group (97.7 ± 2.4% vs. 94.5 ± 3.7%, P < 0.001). The incidence of hemoglobinuria after ablation in the 3D group was lower than that in the 2D group (32.0% vs. 57.6%, P = 0.047). The levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), and creatinine (Cre) after ablation in the 3D group were lower than those in the 2D group (126.7 ± 56.4 U/L vs. 210.9 ± 96.2 U/L, P < 0.001; 141.0 ± 60.8 U/L vs. 211.4 ± 90.0 U/L, P = 0.001; 57.3 ± 17.6 U/L vs. 80.8 ± 41.9 U/L, P = 0.010; and 66.6 ± 16.6 mmol/L vs. 84.5 ± 39.6 mmol/L, P = 0.037, respectively). There were no significant differences in antenna insertion and the volume reduction rate between the groups. One patient developed acute kidney injury shortly after ablation in the 2D group and recovered after hemodialysis. No other severe complications occurred during the follow-up period. The 3D visualization operative planning system has a relatively high clinical application value in providing scientific, reasonable, quantifiable, and individualized therapy for LHHs by US-PMWA.

Background: There is currently a lack of convincing evidence for microwave ablation (MWA) and laparoscopic liver resection (LLR) for patients ≥60 years old with 3–5 cm hepatocellular carcinoma. Materials and methods: Patients were divided into three cohorts based on restricted cubic spline analysis: 60–64, 65–72, and ≥73 years. Propensity score matching (PSM) was performed to balance the baseline variables in a 1:1 ratio. Overall survival (OS) and disease-free survival (DFS) were assessed, followed by a comparison of complications, hospitalization, and cost. Results: Among 672 patients, the median age was 66 (IQR 62–71) years. After PSM, two groups of 210 patients each were selected. During the 36.0 (20.4–52.4) month follow-up period, the 1-year, 3-year, and 5-year OS rates in the MWA group were 97.6, 80.9, and 65.3% and 95.5, 78.7, and 60.4% in the LLR group (HR 0.98, P=0.900). The corresponding DFS rates were 78.6, 49.6, and 37.5% and 82.8, 67.8, and 52.9% (HR 1.52, P=0.007). The 60–64 age cohort involved 176 patients, with no a significant difference in OS between the MWA and LLR groups (HR 1.25, P=0.370), MWA was associated with a higher recurrence rate (HR 1.94, P=0.004). A total of 146 patients were matched in the 65–72 age cohort, with no significant differences in OS and DFS between the two groups (OS (HR 1.04, P=0.900), DFS (HR 1.56, P=0.110)). In 76 patients aged ≥73 years after PSM, MWA provided better OS for patients (HR 0.27, P=0.015), and there were no significant differences in DFS between the two groups (HR 1.41, P=0.380). Taken together, for patients older than 65 years, the recurrence rate of MWA was comparable with LLR. Safety analysis indicated that LLR was associated with more postoperative bleeding (P=0.032) and hypoproteinemia (P=0.024). Conclusions: MWA was comparable to LLR in patients aged 65 years and older. MWA could be an alternative for the oldest old or the ill patients who cannot afford LLR, while LLR is still the first option of treatments for early-stage 3–5 cm hepatocellular carcinoma in capable elderly’s.