Colorectal cancer liver metastases: Biopsy of the ablation zone and margins can be used to predict oncologic outcome Journal Article


Authors: Sotirchos, V. S.; Petrovic, L. M.; Gönen, M.; Klimstra, D. S.; Do, R. K. G.; Petre, E. N.; Garcia, A. R.; Barlas, A.; Erinjeri, J. P.; Brown, K. T.; Covey, A. M.; Alago, W.; Brody, L. A.; DeMatteo, R. P.; Kemeny, N. E.; Solomon, S. B.; Manova-Todorova, K. O.; Sofocleous, C. T.
Article Title: Colorectal cancer liver metastases: Biopsy of the ablation zone and margins can be used to predict oncologic outcome
Abstract: Purpose: To establish the prognostic value of biopsy of the central and marginal ablation zones for time to local tumor progression (LTP) after radiofrequency (RF) ablation of colorectal cancer liver metastasis (CLM). Materials and Methods: A total of 47 patients with 67 CLMs were enrolled in this prospective institutional review board-approved and HIPAA-compliant study between November 2009 and August 2012. Mean tumor size was 2.1 cm (range, 0.6-4.3 cm). Biopsy of the center and margin of the ablation zone was performed immediately after RF ablation (mean number of biopsy samples per ablation zone, 1.9) and was evaluated for the presence of viable tumor cells. Samples containing tumor cells at morphologic evaluation were further interrogated with immunohistochemistry and were classified as either positive, viable tumor (V) or negative, necrotic (N). Minimal ablation margin size was evaluated in the first postablation CT study performed 4-8 weeks after ablation. Variables were evaluated as predictors of time to LTP with the competing-risks model (uni-and multivariate analyses). Results: Technical effectiveness was evident in 66 of 67 (98%) ablated lesions on the first contrast material-enhanced CT images at 4-8-week follow-up. The cumulative incidence of LTP at 12-month follow-up was 22% (95% confidence interval [CI]: 12, 32). Samples from 16 (24%) of 67 ablation zones were classified as viable tumor. At univariate analysis, tumor size, minimal margin size, and biopsy results were significant in predicting LTP. When these variables were subsequently entered in a multivariate model, margin size of less than 5 mm (P , .001; hazard ratio [HR], 6.7) and positive biopsy results (P = .008; HR, 3.4) were significant. LTP within 12 months after RF ablation was noted in 3% (95% CI: 0, 9) of necrotic CLMs with margins of at least 5 mm. Conclusion: Biopsy proof of complete tumor ablation and minimal ablation margins of at least 5 mm are independent predictors of LTP and yield the best oncologic outcomes. © RSNA, 2016.
Journal Title: Radiology
Volume: 280
Issue: 3
ISSN: 0033-8419
Publisher: Radiological Society of North America, Inc.  
Date Published: 2016-09-01
Start Page: 949
End Page: 959
Language: English
DOI: 10.1148/radiol.2016151005
PROVIDER: scopus
PMCID: PMC5006720
PUBMED: 27010254
DOI/URL:
Notes: Article -- Export Date: 3 October 2016 -- Source: Scopus
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MSK Authors
  1. William Alago
    25 Alago
  2. Ronald P DeMatteo
    627 DeMatteo
  3. Mithat Gonen
    782 Gonen
  4. Anne Covey
    134 Covey
  5. David S Klimstra
    917 Klimstra
  6. Kinh Gian Do
    146 Do
  7. Lynn Brody
    100 Brody
  8. Karen T Brown
    171 Brown
  9. Stephen Solomon
    306 Solomon
  10. Joseph Patrick Erinjeri
    111 Erinjeri
  11. Elena Nadia Petre
    58 Petre
  12. Afsar Barlas
    26 Barlas
  13. Nancy Kemeny
    437 Kemeny
  14. Alessandra   Garcia
    6 Garcia