Project for interventional Oncology LArge-database in liveR Hepatocellular carcinoma - Preliminary CT-based radiomic analysis (POLAR Liver 1.1).

OBJECTIVE: The objective of this study is to find a contrast-enhanced CT-radiomic signature to predict clinical incomplete response in patients affected by hepatocellular carcinoma who underwent locoregional treatments. PATIENTS AND METHODS: 190 patients affected by hepatocellular carcinoma treated using focal therapies (radiofrequency or microwave ablation) from September 2018 to October 2020 were retrospectively enrolled. Treatment response was evaluated on a per-target-nodule basis on the 6-months follow-up contrast-enhanced CT or MR imaging using the mRECIST criteria. Radiomics analysis was performed using an in-house developed open-source R library. Wilcoxon-Mann-Whitney test was applied for univariate analysis; features with a p-value lower than 0.05 were selected. Pearson correlation was applied to discard highly correlated features (cut-off=0.9). The remaining features were included in a logistic regression model and receiver operating characteristic curves; sensitivity, specificity, positive and negative predictive value were also computed. The model was validated performing 2000 bootstrap resampling. RESULTS: 56 treated lesions from 42 patients were selected. Treatment responses were: complete response for 26 lesions (46.4%), 18 partial responses (32.1%), 10 stable diseases (17.9%), 2 progression diseases (3.6%). Area-Under-Curve value was 0.667 (95% CI: 0.527-0.806); accuracy, sensitivity, specificity, positive and negative predictive values were respectively 0.66, 0.85, 0.50, 0.59 and 0.79. CONCLUSIONS: This contrast-enhanced CT-based model can be helpful to early identify poor responder's hepatocellular carcinoma patients and personalize treatments.

Percutaneous radiofrequency ablation using internally cooled wet electrodes for the treatment of patients with lung tumors.

OBJECTIVE: To assess the safety and feasibility of computed tomography-guided radiofrequency ablation (CT-guided RFA) in unresectable lung neoplasms, using a new 15G monopolar internally cooled wet electrode. PATIENTS AND METHODS: 15 consecutive patients with lung neoplasms (< 4 cm), both primary and secondary, unsuitable for or refusing surgery, underwent percutaneous CT-guided RFA using a 15G electrode with a 3-cm exposed tip. The prevalence and grade of adverse events and technical success were evaluated, as well as the extension of the ablation zone, the complete response rates, and the time to progression, determined at CT examination performed 1, 6, and 12 months after the procedure. RESULTS: A total of 22 lung neoplasms were treated (mean diameter: 28 mm; range: 20-39 mm). Technical success was obtained in all patients, without major complications or intraprocedural deaths. Mild or moderate pneumothorax was registered in 46.7% of patients, while a perilesional hemorrhage was observed in 5/15 cases. During the follow-up period, a complete response was obtained in 19 out of 22 lesions (86.4%) with three partial response, two of them successfully retreated with the same technique. CONCLUSIONS: Percutaneous RFA using a 15G internally cooled wet electrode is a safe and feasible treatment for unresectable lung neoplasms, with high complete response rates.

A new score predicting intraprocedural risk in patients undergoing CT-guided percutaneous needle pulmonary biopsy (CATH-score).

OBJECTIVE: To develop a new score (CATH-score) for predicting intra-procedural risk in patients undergoing CT-guided percutaneous needle pulmonary biopsy. PATIENTS AND METHODS: 100 CT-guided lung biopsies performed with a 18 Gauge (G) needle (Pilot Group) were reviewed to analyse patient-, lesion- and procedure-related variables to identify risk factors for procedural complications (pneumothorax and parenchymal bleeding) and diagnosis failure. A scoring system for predicting complications and choosing the right needle (16 G, 18 G, 21 G) was developed using risk factors weighting and prospectively applied to 153 consecutive biopsies (CATH-score Group); complications and diagnostic rates obtained were compared with a group of patients (Control Group) that underwent lung biopsy; in this group of patients the choice of the calliper of the needle was based on the operator experience. RESULTS: lesion diameter (p=0.03), central location of lesion (p=0.02), centrilobular emphysema (p=0.04) and trans-pulmonary needle route (p=0.002) were associated with a higher complications rate in Pilot Group and were selected as risk factors to include in the CATH-score definition. Risk factors "cut-off" values were identified (Receiver Operating Characteristics curves) and risk-stratification groups were classified as follows: low (16 G, score 1), intermediate (18 G, score 2), and high procedural risk score (21 G, score 3). CATH-score usage limited complications rate despite a higher number of 16 G needle employed, with a diagnostic performance rising respect to Control Group. CONCLUSIONS: CATH-score seems to be a valuable tool for predicting the risk of complications and choosing the right needle, in order to increase diagnostic performance in patients undergoing TTNA.