What is the role of saline enhancement in percutaneous radiofrequency ablation (RFA) of liver tumors?

Updated: Mar 30, 2021
  • Author: Badar Bin Bilal Shafi, MBBS, MRCP, FRCR, CCT, EBIR; Chief Editor: Kurt E Roberts, MD  more...
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RFA may be performed with saline enhancement. Hypertonic saline is injected into the tumor through a side port on the shaft of the electrode before the ablation is started. The aim is to increase ionicity and, therefore, conduction within the tumor, thereby increasing the volume of the ablation. [44] Tiny channels within the electrodes can be used to infuse very small volumes of saline into the tumor as it is being ablated. Again, the goal is not to enhance conductivity directly but to prevent desiccation and charring of the tumor that would otherwise prevent conductivity and limit the ablation volume.

The unpredictability of saline perfusion in scirrhous colorectal liver metastases makes it unsafe for these lesions. However, encapsulated hepatocellular carcinoma (HCC) can become uniformly perfused without the risk of saline escaping into surrounding tissue, thus allowing ablation diameters of 6-7 cm. RFA using multiple wet electrodes shows promise as an effective method for treating inoperable HCC, especially in cases with well-preserved liver function.


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