Treatment of hepatocellular carcinoma with radiofrequency ablation: Radiologic-histologic correlation during follow-up periods

To determine whether radiographic images after radiofrequency (RF)-induced coagulation necrosis are correlated with the pathologic effects, we evaluated the morphology and histologic characteristics of RF ablation lesions over a 6-month follow-up period and compared the results with those of radiologic studies. Thirty-three hepatocellular carcinoma (HCC) tumors with a maximum diameter of 3 cm or less were treated percutaneously by using RF ablation in 26 patients. Six treated tumors were resected 4 weeks after ablation; the remaining 27 treated tumors underwent a biopsy procedure by using an 18-gauge fine needle 3 days, 4 weeks, and 24 weeks after ablation. The excised or biopsied lesions were examined by using histologic methods; the findings were then compared with those of contrast-enhanced computed tomography (CT). Three days after ablation, a core of hypoattenuation surrounded by an enhanced/hemorrhagic rim was observed on the contrast-enhanced CT images. Hematoxylin-eosin-stained specimens were inconclusive as to whether or not cellular viability remained; however, cell viability as determined by the presence of histochemical (lactate-dehydrogenase, maleate-dehydrogenase, and the reduced form of nicotinamide-adenine dinucleotide phosphate [NADPH]-diaphorase) stains was absent, suggesting 100% cellular destruction in the ablated lesion. Four and 24 weeks after ablation, the sizes of the ablated lesions were progressively smaller on the CT images; the histochemical stains remained superior to the hematoxylin-eosin stains for obtaining a definite diagnosis of cell death. We conclude that irreversible cellular destruction, as determined by the absence of positive histochemical staining patterns, was useful for evaluating the pathologic thermal effect of RF ablation. These pathologic findings can be correlated with those of contrast-enhanced CT.