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What Are the Risks and Outcomes of Seeding in Patients with Hepatocellular Carcinoma?

February 24, 2008
Written by: , Filed in: Abdominal Imaging
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HCC causes nearly one million deaths worldwide per year and is the fifth most common malignant disorder. In patients with HCC, malignant seeding (first reported in 1983) can be a complication of therapeutic and diagnostic procedures.

The objective of a recent study was to analyze the risk of seeding of HCC in patients undergoing percutaneous biopsy and/or therapeutic interventions.

The study has concluded that risks and benefits of biopsy for hepatocellular carcinoma (HCC) need to be weighed carefully, especially when size of the nodule is <2 cm. Methodology
The authors conducted a search of the literature concerning seeding in HCC patients. For this study, needle tract seeding of liver tumor was defined as the development of new neoplastic disease outside of the liver capsule, in either the peritoneal cavity or the subcutaneous soft tissue.

Related CME:
NEW FOR 2009
Abdominal & Thoracic CT/MR/US: Optimizing Practice
The University of California, San Francisco School of Medicine
Evolving technology improves radiological practice through improved image quality for anatomical interpretation and generation of functional data. The use of MDCT and fast, multi-phase imaging sequences also translates to a tremendous increase in data that requires review and handling and greater need for contrast and radiation safety awareness. This activity targets the community radiologist involved in body and cardiovascular imaging with a focus on developing an efficient workflow practice in the modern imaging environment.
Read more or order: Abdominal & Thoracic CT/MR/US: Optimizing Practice

CT/MRI of the Abdomen and Pelvis
University of California San Francisco Department of Radiology and Biomedical Imaging
Provides an updated review on the use of helical (single and multidetector-row) CT and MRI for imaging of the abdomen and pelvis. Participants will learn the current approach and uses of CT/MRI in the examination of the abdomen and pelvis including advances in abdominal MRI techniques, genitourinary applications of CT/MRI, CT colonoscopy, CT/MR angiography, and CT cholangiography.
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Abdominal Imaging CME

Results of the Study
The search yielded 99 articles describing 179 incidences of seeding post-percutaneous interventions, which included biopsy, percutaneous ethanol injection (PEI), radio frequency ablation (RFA), and combined biopsy and percutaneous therapy.

Among these, 66 seedings were reported after biopsy, 26 after PEI, 22 after RFA, and 64 after combined procedure, with median risk defined as 2.29% after biopsy, 1.4% after PEI/biopsy, 0.61% after RFA, 0.95% after RFA with biopsy, and 0.72% for nodules biopsied and ablated.

Conclusions
The risk of seeding is substantial, especially in patients undergoing only biopsy. Seeding may preclude a definitive liver transplantation in patients.

Author: Sohail Contractor, MD

Reference
Stigliano R, Marelli L, et al. Seeding Following Percutaneous Diagnostic and Therapeutic Approaches for Hepatocellular Carcinoma. What Is the Risk and the Outcome? Seeding Risk for Percutaneous Approach of HCC. Cancer Treatment Reviews; 2007; 33 (August): 437-447:

Related CME:
NEW FOR 2009
Abdominal & Thoracic CT/MR/US: Optimizing Practice
The University of California, San Francisco School of Medicine
Evolving technology improves radiological practice through improved image quality for anatomical interpretation and generation of functional data. The use of MDCT and fast, multi-phase imaging sequences also translates to a tremendous increase in data that requires review and handling and greater need for contrast and radiation safety awareness. This activity targets the community radiologist involved in body and cardiovascular imaging with a focus on developing an efficient workflow practice in the modern imaging environment.
Read more or order: Abdominal & Thoracic CT/MR/US: Optimizing Practice

CT/MRI of the Abdomen and Pelvis
University of California San Francisco Department of Radiology and Biomedical Imaging
Provides an updated review on the use of helical (single and multidetector-row) CT and MRI for imaging of the abdomen and pelvis. Participants will learn the current approach and uses of CT/MRI in the examination of the abdomen and pelvis including advances in abdominal MRI techniques, genitourinary applications of CT/MRI, CT colonoscopy, CT/MR angiography, and CT cholangiography.
Earn up to 12 AMA PRA Category 1 Credits™.
Abdominal Imaging CME
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