Ultrasound guidance versus CT guidance with stereotactic navigation in thermal ablation for hepatocellular carcinoma:...

Percutaneous thermal ablation (PTA) is a curative option for early-stage hepatocellular carcinoma (HCC). While ultrasound (US)-guided PTA is widely used, its efficacy may be limited by poor lesion visibility. Computed tomography (CT)-guided PTA with stereotactic navigation offers improved precision, but comparative outcome data remain limited.

We conducted a retrospective cohort study comparing US-guided freehand and CT-guided stereotactic PTA in patients with imaging-confirmed HCC. Patients treated with US-guided PTA (n = 33) at Erasme Hospital between 2005 and 2022 were compared to those treated with CT-guided stereotactic PTA (n = 52) at Antwerp University Hospital between 2020 and 2023. The primary endpoints were incomplete ablation and early local recurrence. Secondary endpoints included postoperative complications, hospital stay, and 12-month local tumor progression-free survival (LTPFS). Lesion-based outcomes were also analyzed, including stratification by anatomical location and depth.

Incomplete ablation was significantly less frequent in the CT-guided group on a per-lesion basis (4.7 % vs. 20.5 %, p = 0.007). Early local recurrence per lesion was also lower with CT guidance (8.5 % vs. 22.6 %, p = 0.038). In anatomically challenging segments (II, IVa, VII, VIII), CT-guided stereotactic PTA demonstrated a pronounced advantage, with significantly fewer incomplete ablations (7.5 % vs. 30.4 %, p = 0.015). Complication rates and median hospital stay (1 day) were similar between groups. CT-guided PTA was further associated with significantly improved 12-month LTPFS (p = 0.004).

CT-guided stereotactic PTA resulted in superior local control and 12-month progression-free survival compared to US-guided PTA, particularly in anatomically challenging lesions. These findings support the use of stereotactic CT guidance for improved ablation outcomes in HCC.