Transpulmonary computed tomography-guided radiofrequency ablation of liver neoplasms abutting the diaphragm with multiple bipolar electrodes.

Background: Neoplasm abutting the diaphragm is one kind of the special sites of liver neoplasms treated with radiofrequency ablation (RFA), the purpose of this study is to evaluate the feasibility and safety of computed tomography (CT)-guided RFA of liver neoplasms abutting the diaphragm with multiple bipolar electrodes sequentially passing through the lung parenchyma. Materials and Methods: 37 patients were treated with transpulmonary CT-guided RFA. Technical success rate, perioperative complications, and local tumor progression were investigated. Results: The number of electrode (s) sequentially passing through the lung parenchyma (NPLP) was 1 electrode in 20 patients, 2 electrodes in 14 cases, and 3 electrodes in 3 cases. Technical success rate was 100%. The most of the perioperative complications were self-limiting and mainly included pneumothorax (11 cases, 2 needed percutaneous drainage), hemorrhage of the electrode track in the lung parenchyma (6 cases), a small amount of hemoperitoneum in perihepatic space (8 cases) and discomfort of the right shoulder (7 cases). Local tumor progression occurred in 6 cases during the follow-up (3–12 months). Multivariate logistic regression analysis showed that the incidence of pneumothorax was not related to NPLP ( P = 0.50), length of the electrode (s) in the lung parenchyma ( P = 0.18), types of anesthesia ( P = 0.10), and indwelling time of the electrode (s) in the lung parenchyma ( P = 0.28). Conclusion: CT-guided RFA of liver neoplasms abutting the diaphragm with multiple bipolar electrodes sequentially passing through the lung parenchyma is a feasible and safe therapeutic option.