Comparative Effectiveness of Computed Tomography- Versus Ultrasound-Guided Percutaneous Radiofrequency Ablation Among Medicare Patients 65 Years of Age or Older With Hepatocellular Carcinoma

Abstract

Background: For patients with hepatocellular carcinoma (HCC) not eligible for surgical resection, radiofrequency ablation (RFA) is a promising technique that reduces the risk of disease progression. Objectives: To evaluate whether the trend of image guidance for RFA is moving toward the more expensive computed tomography (CT) technology and to determine the clinical benefits of CT guidance over the ultrasound (US) guidance. Methods: A cohort of 463 patients was identified from the Surveillance, Epidemiology, and End Results and Medicareelinked database. The temporal trends in use of image guidance were assessed using the CochraneeArmitage test. The associations between modality of image guidance and survival, complications, and costs were assessed using the Cox regression model, the logistic regression model, and the generalized linear model, respectively. Results: The use of CT-guided RFA increased sharply, from 20.7% in 2002 to 75.9% in 2011. Compared with CT-guided RFA, those who received US-guided RFA had comparable risk of periprocedural and delayed postprocedural complications. Stratified analyses by tumor size also showed no statistically significant difference. In adjusted survival analysis, no statistically significant difference was observed in overall and cancer-specific survival. Nevertheless, the cost of CT-guided RFA

Security and Efficiency of Percutaneous Microwave Ablation using Combined Computed Tomography and Ultrasound-Guided Imaging in Patients with Hepatocellular Carcinoma: A Prospective Study

“…In our analysis, we prospectively compared the effectiveness and safety of US, CT, and combinationguided percutaneous MWA in treating patients with HCC. The local recurrence and grade C complication rates were not signi cantly different between patients with CT and US-guided MWA, which was consistent with the ndings of a previous related study [14,21]. US has the advantages of real-time monitoring, a short operation time, and a clear display of blood vessels and the bile duct, while CT has a high accuracy of puncture and a high image resolution [3,4].…”

“…However, the limited literature comparing the thermal ablation of HCC under the guidance of CT and US has shown that both of these techniques have excellent outcomes [14]. It is worth noting that the postprocedural complication rates of thermal ablation vary greatly, from 2.2% to 53.2% [14,15]; we cannot say that this is not in uenced by the method of imaging guidance.…”

“…However, the limited literature comparing the thermal ablation of HCC under the guidance of CT and US has shown that both of these techniques have excellent outcomes [14]. It is worth noting that the postprocedural complication rates of thermal ablation vary greatly, from 2.2% to 53.2% [14,15]; we cannot say that this is not in uenced by the method of imaging guidance. Both types of imaging guidance have their own disadvantages; to overcome these limitations, various methods have been proposed by researchers to achieve this goal, such as CT/MRI-CEUS and US-CEUS fusion imaging techniques and multimodality imaging-compatible insertion robots [16][17][18][19].…”

“…The median follow-up period was 14 (12)(13)(14)(15)(16)(17)(18)(19)(20) months. During the follow-up period, 8 patients (combination group: 2 patients, CT group: 2 patients, US group: 4 patients) experienced local recurrence and received repeat MWA, and the local recurrence rates were 5.9%, 6.7%, and 16.7% in the combination group, CT group, and US group, respectively.…”

Safety and effectiveness of percutaneous microwave ablation using combined computed tomography and ultrasound-guided imaging in patients with hepatocellular carcinoma: A prospective study

“…The median follow-up period was 14 (12)(13)(14)(15)(16)(17)(18)(19)(20) months. During the follow-up period, 8 patients (combination group: 2 patients, CT group: 2 patients, US group: 4 patients) experienced local recurrence and received repeat MWA, and the local recurrence rates were 5.9%, 6.7%, and 16.7% in the combination group, CT group, and US group, respectively.…”