微波消融治疗原发性肝细胞癌后针道种植转移5例

Needle tract tumor seeding after microwave ablation of primary hepatocellular carcinoma:Report of 5 cases

目的观察微波消融(MWA)治疗原发性肝细胞癌(pHCC)后针道种植转移(NTTS)影像学表现。方法纳入1018例接受MWA治疗的pHCC患者,记录NTTS影像学表现,分析其影响因素。结果1018例中,5例(5/1018,0.49%)分别于MWA治疗后8~75个月发生NTTS,种植部位包括膈肌、胸腹壁、腹腔及大网膜;MRI于5例均见穿刺针道附近混杂信号,动脉期及静脉期呈持续性强化;超声造影(CEUS)显示种植灶于增强早期呈稍高增强、增强晚期呈低增强。MWA治疗过程中是否使用套管穿刺、多针穿刺,以及经肝左叶或肝右叶穿刺对NTTS均无显著影响(P均>0.05)。对种植灶予外科切除,术后病理结果均为HCC;随访中1例出现心膈角淋巴结转移,其余4例均无瘤生存。结论MWA治疗pHCC引发NTTS概率较低,其影像学表现为穿刺针道附近混杂MR信号于动脉期及静脉期增强扫描呈持续性强化,CEUS早期呈稍高增强、晚期呈低增强。

Objective To observe imaging manifestations of needle tract tumor seeding(NTTS)after microwave ablation(MWA)of primary hepatocellular carcinoma(pHCC).Methods Totally 1018 HCC patients who underwent MWA were enrolled.Imaging manifestations of NTTS were recorded,and the impact factors of NTTS were analyzed.Results Among 1018 cases,NTTS occurred in 5 cases(5/1018,0.49%)from 8-75 months after MWA in the diaphragm,chest and abdominal wall,abdominal cavity and the greater omentum,respectively.MRI detected mixed signals near the puncture needle path,with continuous enhancement in both arterial and venous phases,while contrast-enhanced ultrasound(CEUS)showed early stage slight high enhancement and late stage low enhancement.The use or not of cannula puncture,whether multi-needle puncture,transhepatic puncture of left or right lobe did not significantly impact the incidence of NTTS(all P>0.05).Surgical resection of the implantation site was performed in all 5 cases with NTTS,and HCC was proved pathologically.During follow-up,among 5 cases with NTTS,lymph node metastasis in the diaphragmatic angle was detected in 1 case,while tumor free survival was observed in 4 cases.Conclusion The probability of NTTS after MWA for treating HCC was low.Imaging manifestations of NTTS included mixed signals near the puncture needle,with continuous arterial and venous phase enhancement on MRI,as well as slightly early stage high enhancement and late stage low enhancement during CEUS.