Purpose: This systematic review aims to identify, evaluate, and summarize the findings of the literature on existing computational models for radiofrequency and microwave thermal liver ablation planning and compare their accuracy. Methods: A systematic literature search was performed in the MEDLINE and Web of Science databases. Characteristics of the computational model and validation method of the included articles were retrieved. Results: The literature search identified 780 articles, of which 35 were included. A total of 19 articles focused on simulating radiofrequency ablation (RFA) zones, and 16 focused on microwave ablation (MWA) zones. Out of the 16 articles simulating MWA, only 2 used in vivo experiments to validate their simulations. Out of the 19 articles simulating RFA, 10 articles used in vivo validation. Dice similarity coefficients describing the overlap between in vivo experiments and simulated RFA zones varied between 0.418 and 0.728, with mean surface deviations varying between 1.1 mm and 8.67 mm. Conclusion: Computational models to simulate ablation zones of MWA and RFA show considerable heterogeneity in model type and validation methods. It is currently unknown which model is most accurate and best suitable for use in clinical practice.

Background: Early detection of patients at high risk for recurrence or local tumor progression (LTP) following thermal ablation of hepatocellular carcinoma (HCC) is essential for treatment selection and individualized follow-up. This systematic review aims to assess and compare the performance of prognostic models predicting recurrence or LTP in patients with HCC treated with thermal ablation. Methods: PubMed, Web of Science, Cochrane, and Embase were searched for studies developing models to predict recurrence after thermal ablation in treatment-naïve HCC patients, using imaging and clinical data with reported test set performance. Risk of bias and applicability were assessed by the Prediction model Risk of Bias Assessment Tool. Data on model performance, feature extraction and modeling technique was collected. Results: In total, 16 studies comprising 39 prognostic models were included, all developed using retrospective data from China or Korea. Outcomes included recurrence-free survival, (intrahepatic) early recurrence, LTP, late recurrence and aggressive intrasegmental recurrence. Predictive parameters varied across models addressing identical outcomes. Outcome definitions also differed. Nine models were externally validated. Most studies had a high risk of bias due to methodological limitations. Conclusions: Variability in model development methodology and type of predictors was found. Models that integrated multiple types of predictors consistently outperformed those relying on one type. To advance predictive tools toward clinical implementation, future research should prioritize standardized outcome definitions, external testing, and transparent reporting. Until these challenges are addressed, current evaluated models should be regarded as promising but preliminary tools.

Purpose: Currently, significant medical practice variation exists in thermal ablation (TA) of malignant liver tumors with associated differences in outcomes. The IMaging and Advanced Guidance for workflow optimization in Interventional Oncology (IMAGIO) consortium aims to integrate interventional oncology into the standard clinical pathway for cancer treatment in Europe by 2030, by development of a standardized low-complex-high-precision workflow for TA of malignant liver tumors. This study was conducted at the start of the IMAGIO project with the aim to explore the current state and future role of modern technology in TA of malignant liver tumors. Materials and Methods: A cross-sectional questionnaire was conducted followed by an expert focus group discussion with core members and collaborating partners of the consortium. Results: Of the 13 participants, 10 respondents filled in the questionnaire. During the focus group discussion, there was consensus on the need for international standardization in TA and several aspects of the procedure, such as planning based on cross-sectional images, the adoption of different techniques for needle placement and the importance of needle position- and post-ablative margin confirmation scans. Yet, also considerable heterogeneity was reported in the adoption of modern technology, particularly in navigational systems and computer-assisted margin assessment. Conclusion: This study mirrored the current diversity in workflow of thermal liver ablation. To obtain comparable outcomes worldwide, standardization is needed. While advancements in tools and software hold the potential to homogenize outcome measurement and minimize operator-dependent variability, the rapid increase in availability also contributes to enhanced workflow variation. Graphical