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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2025; 35(01): 017-024
DOI: 10.1055/s-0044-1788574
Original Article

Imaging Classification of Exophytic HCC and Our Experience with Microwave Ablation of Type 2 Lesions

Soumil Singhal 
1   Department of Interventional Radiology, Medanta–The Medicity, Gurugram, Haryana, India
,
Pallav Bhatter
1   Department of Interventional Radiology, Medanta–The Medicity, Gurugram, Haryana, India
,
Girendra Shankar
1   Department of Interventional Radiology, Medanta–The Medicity, Gurugram, Haryana, India
,
Anubhav Khandelwal
1   Department of Interventional Radiology, Medanta–The Medicity, Gurugram, Haryana, India
,
Sanjay Saran Baijal
1   Department of Interventional Radiology, Medanta–The Medicity, Gurugram, Haryana, India
› Author Affiliations Funding None.
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Abstract

Purpose The purpose of this article is to classify hepatocellular carcinoma (HCC) based on imaging and to evaluate the role of ultrasound-guided microwave ablation (MWA) in the management of type 2 exophytic HCC.

Materials and Methods A retrospective study was performed at our institution after approval by the Institutional Review Board. The study was undertaken from January 2017 to May 2022. Based on the location, HCC was classified and categorized on cross-sectional imaging into four types. All MWA procedures were performed using ultrasound guidance. Patients were followed up every 3 months with cross-sectional imaging.

Results During the study period, 225 lesions were reviewed. MWA was performed in 13 type 2 exophytic HCC patients. Segment 3 (38%) was the most common site when categorized as per Couinaud classification and segment 6 was the next common site. Technical success of complete ablation, evaluated by postprocedure contrast-enhanced computed tomography scan, was 100%. The median follow-up period was 24 months (range: 9–24 months). One patient presented with a residual lesion on the first follow-up at 30 days. Two other patients followed up to 9 months were free of HCC. Ten patients followed up at 1 year showed no recurrence, while 7 of them were followed up for 24 months, and 1 of whom showed multicentric recurrence which was treated by selective intra-arterial radiation therapy.

Conclusion A classification system for exophytic lesions can allow for better patient selection, planning, and reporting of ablative outcomes. MWA has performed well when ablating these technically challenging lesions with a certain degree of planning.

Keywords

ablation - classification - HCC - microwave ablation


Publication History

Article published online:
17 July 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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