Tombesi P, Cutini A, Grasso V, Di Vece F, Politti U, Capatti E, Labb F, Petaccia S, Sartori S. Past, present, and future perspectives of ultrasound-guided ablation of liver tumors: Where could artificial intelligence lead interventional oncology? Artif Intell Cancer 2024; 5(1): 96690 [DOI: 10.35713/aic.v5.i1.96690]
Corresponding Author of This Article
Sergio Sartori, MD, Adjunct Professor, Chief Doctor, Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Via A. Moro 8, Ferrara 44100, Italy. srs@unife.it
Research Domain of This Article
Oncology
Article-Type of This Article
Editorial
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Past, present, and future perspectives of ultrasound-guided ablation of liver tumors: Where could artificial intelligence lead interventional oncology?
Paola Tombesi, Andrea Cutini, Valentina Grasso, Francesca Di Vece, Ugo Politti, Eleonora Capatti, Florence Labb, Stefano Petaccia, Sergio Sartori
Paola Tombesi, Andrea Cutini, Valentina Grasso, Francesca Di Vece, Ugo Politti, Eleonora Capatti, Sergio Sartori, Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Ferrara 44100, Italy
Co-first authors: Paola Tombesi and Sergio Sartori.
Author contributions: Tombesi P, Cutini A, Grasso V, Di Vece F, Politti U, Capatti E, Labb F, Petaccia S, and Sartori S equally contributed to conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: All authors declare no conflicts of interest related to this publication.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sergio Sartori, MD, Adjunct Professor, Chief Doctor, Department of Internal Medicine, Section of Interventional Ultrasound, St. Anna Hospital, Via A. Moro 8, Ferrara 44100, Italy. srs@unife.it
Received: May 14, 2024 Revised: June 26, 2024 Accepted: July 10, 2024 Published online: July 18, 2024 Processing time: 63 Days and 23.9 Hours
Abstract
The first ablation procedures for small hepatocellular carcinomas were percutaneous ethanol injection under ultrasound (US) guidance. Later, radiofrequency ablation was shown to achieve larger coagulation areas than percutaneous ethanol injection and became the most used ablation technique worldwide. In the past decade, microwave ablation systems have achieved larger ablation areas than radiofrequency ablation, suggesting that the 3-cm barrier could be broken in the treatment of liver tumors. Likewise, US techniques to guide percutaneous ablation have seen important progress. Contrast-enhanced US (CEUS) can define and target the tumor better than US and can assess the size of the ablation area after the procedure, which allows immediate retreatment of the residual tumor foci. Furthermore, fusion imaging fuses real-time US images with computed tomography or magnetic resonance imaging with significant improvements in detecting and targeting lesions with low conspicuity on CEUS. Recently, software powered by artificial intelligence has been developed to allow three-dimensional segmentation and reconstruction of the anatomical structures, aiding in procedure planning, assessing ablation completeness, and targeting the residual viable foci with greater precision than CEUS. Hopefully, this could lead to the ablation of tumors up to 5-7 cm in size.
Core Tip: Starting from the first experiences with ethanol injection, constant technical improvements in both thermal ablation and ultrasound imaging have led clinicians in interventional oncology to break the so-called 3-cm barrier in the percutaneous treatment of primary and secondary liver tumors. At present, advanced software powered by artificial intelligence has been developed to precisely target tumor margins and/or residual viable tumor tissue, opening the way to the percutaneous ablation of tumors up to 5-7 cm in size.
