Background and Objectives: To report on the first results of safety, efficacy, and outcome of CT-navigated stereotactic percutaneous electrochemotherapy (SpECT) in patients with primary and secondary liver malignancies. Methods: This retrospective study included 23 consecutive lesions in 22 patients who underwent SpECT for primary and secondary malignant liver lesions with locally curative intention. The endpoints were primary technique efficacy (PTE), local tumor progression (LTP), time to progression (TTP), and occurrence of adverse events. Results: The mean maximum diameter of the treated lesions was 42 mm (range: 16 mm–72 mm). Eight lesions were hepatocellular carcinoma (34.8%), five lesions were colorectal liver metastases (21.7%), three lesions were cholangiocellular carcinoma (13.0%), and the other seven lesions were liver metastases from different primary cancers (30.4%). PTE was achieved for 22 lesions (95.7%). The mean follow-up time was 15 months (0–39 months). No LTP was observed. In six patients (27.3%), hepatic tumor progression was observed during follow-up with a mean TTP of 3.8 months (2–8 months). In 10 procedures (43.5%), minor complications (1 CIRSE Grade 2) and side effects occurred, but no major complications were observed. Conclusions: SpECT seems to be a safe and effective new local treatment modality for primary and secondary liver malignancies.

Purpose: To evaluate the efficacy and safety of the Surgnova Dophi™ M150E microwave ablation system in a prospective single-center observational study. Methods: A cohort of 50 patients with 77 primary or secondary liver tumors underwent CT-navigated stereotactic percutaneous microwave ablation with curative intention using the Surgnova Dophi™ M150E system. The endpoints were primary technique efficacy (PTE), number of complications, ablation defect dimensions, and sphericity index compared to previously reported findings. Results: The PTE was 97.4%, with complete ablation in 75 out of 77 tumors. Complications occurred in 10% of patients, with 4% classified as major. A comparison with previous in vivo data confirmed the reliability of the system in achieving reproducible and predictable ablation results. Conclusions: Stereotactic percutaneous microwave ablation with the Surgnova Dophi™ M150E system is safe and effective for liver tumor treatment.

Purpose: To assess safety and outcomes of stereotactic CT-guided microwave ablation (MWA) for hepatocellular carcinoma (HCC) in patients with transjugular intrahepatic portosystemic shunts (TIPS) versus a matched control group without TIPS. Materials and Methods: Retrospective matched case–control study of cirrhotic patients with HCC treated with stereotactic CT-guided MWA. TIPS patients were matched 1:1 to controls using hierarchical matching based on Child–Pugh class, number of treated tumors, MELD score, tumor diameter, and ablation date. Primary endpoints were primary technique efficacy (PTE), local tumor progression (LTP), 30-day complications, and 30-day all-cause mortality. Secondary endpoints were 12-month Kaplan–Meier estimates for progression-free survival (PFS), hepatic decompensation-free survival (HDFS), and overall survival (OS), compared using log-rank tests. Results: 46 patients (23 TIPS, 23 controls) with 62 index lesions were analyzed. PTE was achieved in 30/31 lesions (96.8%) in both groups. Among lesions with PTE, LTP occurred in 1/30 lesions (3.3%) in the TIPS group and 0/30 lesions (0%) in controls. Within 30 days, two major complications occurred in the TIPS group and one in the control group; no 30-day deaths occurred. Observed 12-month estimates did not differ significantly between groups for PFS (52.4% vs. 46.0%, p = 0.876), HDFS (71.8% vs. 76.9%, p = 0.519), or OS (91.1% vs. 90.0%, p = 0.903). Child–Pugh A was associated with higher HDFS than Child–Pugh B (95.8% vs. 50.2%, p = 0.001). Conclusion: Stereotactic CT-guided MWA of early-stage HCC appears feasible in carefully selected patients with TIPS, warranting further evaluation in larger cohorts. Level of Evidence: 3b.

Objective: Irreversible electroporation (IRE) is a non-thermal ablation technique suitable for tumors near critical structures, but its widespread use is limited by technical complexity and the need for multiple electrodes. This study aimed to evaluate the feasibility, safety, and efficacy of a stereotactic percutaneous two-needle IRE approach for small liver tumors in anatomically challenging locations. Materials and methods: In this retrospective study, 17 consecutive patients with 18 primary or secondary liver tumors (≤ 2.0 cm) adjacent to critical anatomical structures underwent CT-navigated stereotactic two-needle IRE between December 2021 and May 2025. Ablation was performed with a high-dose protocol (2 × 90 pulses, 90 µs, > 20 A). Primary endpoints were primary technique efficacy (PTE) and local tumor progression (LTP); secondary endpoints included complications. Needle placement was assessed through geometric analysis. Results: PTE was obtained in 17/18 tumors (94.4%, 95% confidence interval (CI): 72.7–99.9%). At a median follow-up of 12.4 months, LTP occurred in 1/18 tumors (5.6%, 95% CI: 0.1–27.3%). No complications or procedure-related mortality were observed. Geometric analysis showed high accuracy of stereotactic needle placement, while treatment failure was associated with suboptimal geometry. Conclusion: Stereotactic percutaneous two-needle IRE seems to be technically feasible with a favorable safety profile for small liver tumors in anatomically challenging locations and may offer a simplified alternative to multielectrode approaches. However, given the small, retrospective single-center design, these findings are preliminary and require prospective multicenter validation to establish oncologic effectiveness and generalizability. Relevance statement: Stereotactic two-needle irreversible electroporation offered a simplified, safe, and effective alternative to multielectrode ablation, potentially broadening treatment options for liver tumors near critical structures and improving accessibility, reproducibility, and outcomes in interventional oncology. Key Points: First systematic clinical evaluation of stereotactic two-needle irreversible electroporation (IRE) for liver tumors. Two-needle configuration with high-dose protocol simplifies IRE compared with standard multielectrode approaches. This proof-of-concept study demonstrates high efficacy and absence of complications in small liver tumors near critical structures. Two-needle IRE may broaden clinical applicability in anatomically challenging locations. Graphical

Objective: To evaluate the safety, diagnostic yield, and ablation efficacy of a single-session workflow combining stereotactic percutaneous core-needle biopsy (CNB) immediately followed by microwave ablation (MWA) for liver tumors. Methods: We retrospectively reviewed consecutive patients (December 2021–May 2025) who underwent stereotactic CNB followed by MWA in the same procedure. Primary endpoints were primary technique efficacy (PTE) and complications. Secondary endpoints were 6-month local tumor progression (LTP) and diagnostic yield. Six-month LTP was summarized using a Kaplan–Meier (KM) point estimate with Greenwood 95% CIs. Results: Thirty-three patients underwent single-session biopsy and ablation (33 biopsied; 41 lesions ablated). PTE was 95.1% (39/41); two residual tumors were successfully re-ablated. Six-month LTP was 3.6% (patient level; KM 95% CI 0.0–10.5%) and 2.8% (lesion level; KM 95% CI 0.0–8.2%). There was one major complication (3%, post-ablation abscess) and no minor complications. Adequate tissue was obtained in all biopsies; a definitive diagnosis was established in 88% (29/33): malignancy in 73% (24/33) and benignity in 15% (5/33); 12% (4/33) were nondiagnostic. In the hepatocellular carcinoma (HCC)-suspected subgroup (LI-RADS LR-3 to LR-5; n = 24), all LR-5 lesions were HCC (11/11). Among LR-4 lesions (n = 7), histology showed HCC in 1/7 (14%) and cholangiocarcinoma in 2/7 (29%); 4/7 (57%) were benign or nondiagnostic. Among LR-3 lesions (n = 6), 2/6 (33%) were HCC and 4/6 (67%) were benign or nondiagnostic. In the metastasis-suspected subgroup (n = 9), malignancy was confirmed in 8/9 (89%); 1/9 (11%) was nondiagnostic. Conclusions: Single-session stereotactic CNB followed by MWA is feasible and safe, yields diagnostically useful tissue, and achieves high ablation efficacy.