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A review of conventional and newer generation microwave ablation systems for hepatocellular carcinoma

  • Special Feature: Review Article
  • Differential diagnosis and treatment of hepatocellular carcinoma: the role of ultrasound
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Abstract

Although microwave ablation (MWA) exhibits a high thermal efficiency, the major limitation of conventional MWA systems is the lack of predictability of the ablation zone size and shape. Therefore, a specific newer generation MWA system, The Emprint™ Ablation System with Thermosphere™ Technology, was designed to create predictable large spherical zones of ablation that are not impacted by varying tissue environments. The time required for ablation with MWA systems is short, and the shape of the necrosis is elliptical with the older systems and spherical with the new system. In addition, because MWA has no heat-sink effect, it can be used to ablate tumors adjacent to major vessels. Although these factors yield a large ablation volume and result in good local control, excessive ablation of liver tissue and unexpected ablation of surrounding organs are possible. Therefore, MWA should be carefully performed. This review highlights the efficacy and complications of MWA performed with conventional systems and the newer generation system in patients with hepatocellular carcinoma (HCC). MWA with the newer generation system seems to be a promising treatment option for large HCCs and secondary hepatic malignancies, with several advantages over other available ablation techniques, including conventional MWA. However, further randomized controlled trials are necessary to fully clarify the benefits and pitfalls of this new system.

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Abbreviations

BCLC:

Barcelona clinic liver cancer

CEUS:

Contrast-enhanced ultrasonography

CT:

Computed tomography

ECOG:

Eastern Cooperative Oncology Group

EM:

Electromagnetic

HCC:

Hepatocellular carcinoma

HR:

Hepatic resection

MWA:

Microwave ablation

MRI:

Magnetic resonance imaging

NICE:

National Institute for Health and Care Excellence

OLT:

Orthotopic liver transplantation

OS:

Overall survival

PLA:

Percutaneous local ablation

RCT:

Randomized controlled trial

RFA:

Radiofrequency ablation

RFS:

Relapse-free survival

RI:

Roundness index

SMWA:

Stereotactic image-guided microwave ablation

TACE:

Transarterial chemoembolization

US:

Ultrasonography

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Funding

Work in the author’s laboratory was supported by the “Step A” program of the Japan Science and Technology Agency (JST) and Kiban-B, Shingakujuturyouiki. In addition, this work was supported in part by grants-in-aid from the Japanese Ministry of Health, Labour and Welfare.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan

    Kento Imajo, Yuji Ogawa, Masato Yoneda, Satoru Saito & Atsushi Nakajima

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  1. Kento Imajo
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  2. Yuji Ogawa
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  3. Masato Yoneda
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  4. Satoru Saito
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  5. Atsushi Nakajima
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Correspondence to Atsushi Nakajima.

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Imajo, K., Ogawa, Y., Yoneda, M. et al. A review of conventional and newer generation microwave ablation systems for hepatocellular carcinoma. J Med Ultrasonics 47, 265–277 (2020). https://doi.org/10.1007/s10396-019-00997-5

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