Two probe microwave ablation of a big liver metastasis

Tissue spearing microwave ablation after extended right hemihepatectomy. Lesion, progressive in size to 43 x 36 mm at the time of the intervention, was fully covered by the ablation volume. In addition a 5-mm satellite tumour dorsocranial to the main lesion showed in the planning scan. They were treated with a double needle configuration and repositioning after the initial ablation. In the postinterventional control scan, the lesion was completely covered without evidence of periinterventional complications.

01_Plan2_2022-01-17Freiburg_case

Planning scan showing the two trajectories with the expected big ablation zone of the dual needle configuration

02_Needle2_3dFreiburg_case
Needle verification scan of placed needles
 
03_Assess_2022-01-21 142753_freiburg_case
Showing the margin assessement of the ablation zone with Ablasure (with some artefacts due to needles still in place)
 
04_Second_Plan_2022-01-17 142524_freiburg_case
Planning of re-ablation to increase the size of the ablation zone and cover the satellite lesion as well


Name: Prof. Dr. Wibke Uller and Dr. Michael Doppler 


Institution: Universitätsklinikum Freiburg, Freiburg (Germany)


Patient age and sex: 64 years, male


Initial condition:

  • 2016: Initial diagnosis of a neuroendocrine tumour of the pancreatic head. Condition after laparoscopic enucleation
  • 2017: During follow-up, hepatic space-occupying lesions were noted, as well as a stenosing space-occupying lesion of the right colonic felxur. Histological confirmation of the space-occupying mass of the colon (adenocarcinoma of the colon)
  • 2017: right hemicolectomy, and atypical liver resection from liver segments II/III, III, and extended right hemihepatectomy (multi-stage procedure). Detection of hepatic metastases of adenocarcinoma of the colon in the intraoperative fast track samples
  • Since 2017: inconspicuous follow-up
  • November 2021: Newly appeared mass in the central residual liver (39 x 32 mm)
  • December 2021: Tumour board decision for microwave ablation

Treatment: 

  • January 2022: Bioptic confirmation and MWA of the focus (pathology: metastasis of adenocarcinoma of the colon). In CT accompanying the examination, the lesion was progressive in size to currently 43 x 36 mm
  • In addition, a new 5-mm satellite dorsocranial to the main lesion was seen compared with the previous findings

Conclusion: 

  • In the postinterventional control, the lesion was completely covered without evidence of periinterventional complications
  • Follow-up by MRI or CT is still pending

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