Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Sep 14:12:8425-8433.
doi: 10.2147/CMAR.S261838. eCollection 2020.

Evaluation of Alterations to Bile Ducts and Laboratory Values During the First 3 Months After Irreversible Electroporation of Malignant Hepatic Tumors

Wolf Bäumler  1 , Mareike Sebald  2 , Ingo Einspieler  1 , Andreas Schicho  1 , Jan Schaible  1 , Philipp Wiggermann  3 , Marco Dollinger  1 , Christian Stroszczynski  1 , Lukas Philipp Beyer  4
Affiliations

Evaluation of Alterations to Bile Ducts and Laboratory Values During the First 3 Months After Irreversible Electroporation of Malignant Hepatic Tumors

Wolf Bäumler et al. Cancer Manag Res. .

Abstract

Purpose: To assess the incidence and evolution of biliary alterations adjacent to the ablation area in patients with hepatic malignancies during the first 3 months after percutaneous irreversible electroporation (IRE) and to investigate associated changes in laboratory values.

Material and methods: Bile ducts located within a ≤1.0 cm radius of the ablation zone were analyzed in 45 patients by preinterventional and postinterventional MRI (1-3 days, 6 weeks, and 3 months after IRE). Moreover, levels of alkaline phosphatase (AP) and serum bilirubin (SB) were examined for evidence of bile duct injury. Biliary alterations and the presence of postinterventional-elevated laboratory levels were correlated with features of the lesions, patients, ablation procedures, and laboratory values.

Results: A total of 80 bile ducts were located within a 1.0 cm radius of the ablation zone: 59 were encased, 16 were abutting and 5 were located within a radius of 0.1-1.0 cm of the ablation area. In total, 38 biliary injuries (narrowing, n=22; dilatation, n=14; biloma, n=2) were detected, 3 cases of narrowing occurred for the first time 6 weeks and 3 months after IRE, 21 alterations (dilatation: n=9; narrowing; n=10; biloma: n=2) had resolved during the first 6 weeks, 1 alteration (dilatation: n=1) had resolved by the last follow-up control. Three months after IRE, 19 patients showed elevated levels of AP, whereas SB levels were increased in 10 cases. No significant association between biliary alterations or postinterventional-elevated laboratory values and the investigated characteristics of lesions, patients, ablation procedures or laboratory values could be proven.

Conclusion: Different alterations of bile ducts adjacent to an IRE ablation zone are common, of which dilatation and especially narrowing commonly represent a long-term complication after IRE. Moreover, a definite correlation between the frequently observed prolonged post-ablative elevation of AP- and SB-levels and the postinterventional biliary alterations could not be proven.

Keywords: bile ducts; electroporation; hepatic tumors.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
An 80-year-old woman with a centrally located HCC. (A) Coronal contrast-enhanced T1 vibe 3d fat-suppressed magnetic resonance imaging, conducted preinterventionally during the hepatobiliary phase, shows a centrally located HCC (white arrow) and a left major bile duct without any relevant narrowing (red arrow). (B) One day after IRE, coronal contrast-enhanced T1 vibe 3d fat-suppressed magnetic resonance imaging, conducted during the hepatobiliary phase, shows a hypointense ablation defect (white arrow) and a newly occurred narrowing of the left major bile duct (red arrow).
Figure 2
Figure 2
A 67-year-old man with a centrally located HCC. (A) Axial contrast-enhanced T1 vibe 3d fat-suppressed magnetic resonance imaging, conducted preinterventionally during the hepatobiliary phase, shows a centrally located HCC (white arrow) and a major bile duct without any dilatation (red arrow). (B) One day after IRE, axial contrast-enhanced T1 vibe 3d fat-suppressed magnetic resonance imaging, conducted during the hepatobiliary phase, shows a slightly grown, hypointense ablation defect (white arrow) and a newly occurred mild dilatation of the major bile duct (red arrow).
See this image and copyright information in PMC

References

    1. Crocetti L, de Baere T, Lencioni R. Quality improvement guidelines for radiofrequency ablation of liver tumors. Cardiovasc Intervent Radiol. 2010;33(1):11–17. doi: 10.1007/s00270-009-9736-y - DOI - PMC - PubMed
    1. Ahmed M. Technology Assessment Committee of the Society of Interventional Radiology. Image-guided tumor ablation: standardization of terminology and reporting criteria-a 10-year update: supplement to the consensus document. J Vasc Interv Radiol. 2014;25(11):1706–1708. doi: 10.1016/j.jvir.2014.09.005 - DOI - PubMed
    1. Rubinsky B, Onik G, Mikus P. Irreversible electroporation: a new ablation modality - clinical implications. Technol Cancer Res Treat. 2007;6(1):37–48. doi: 10.1177/153303460700600106 - DOI - PubMed
    1. Silk MT, Wimmer T, Lee KS, et al. Percutaneous ablation of peribiliary tumors with irreversible electroporation. J Vasc Interv Radiol. 2014;25(1):112–118. doi: 10.1016/j.jvir.2013.10.012 - DOI - PubMed
    1. U.S. Department of Health and Human Services. Common Terminology Criteria for Adverse Events (CTCAE). Version 5.0; November 27, 2017. Available from: https://ctep.cancer.gov/protocoldevelopment/electronic_applications/docs.... Accessed September5, 2020.