03:18 PM Abstract No. 181 Utility and safety of large core coaxial needle biopsy for biorepository tissue acquisition during MWA of HCC: initial experience in an US Hispanic population

To report our initial experience with the use of a large core (14 G) coaxial needle biopsy during MWA of HCC for Biorepository Tissue acquisition in an US Hispanic patient population with HCC. Between July 2016 – August 2018, 19 US Hispanic patients (3 F, M 16, ages 50-74 mean 65) with HCC where included in this prospective, IRB-approved study. Tumor size ranged from 1.8 cm to 5.2 cm, mean 2.9 cm. A coaxial 13.5 G needle (Achieve) was advanced in the periphery of the tumor under US and/or CT guidance. A 14 G cutting needle was used to obtain two 2 cm cores. Two passes were made in each patient. One pass was cut in two pieces and a 1 cm fragment was sent to pathology for histological examination. The other portions (75%) of tissue were sent to the Biorepository for establishing liver cancer cell lines, tumor lines in mice, and long-term storage. After the biopsy a 15 G Solero MWA probe (Angiodynamics) was advanced through the coaxial needle and the tumors were ablated in a standard fashion. Tract ablation was performed by pulling the coaxial and the ablation needle together. Patients were followed- up by serial imaging and clinics visits Biopsy and ablation was possible in all patients. Histological analysis confirmed HCC in 13 patients (grade 1 (n=5), grade 2 (n=5), grade 3 (n= 3)) . Atypical nodules were seen in 3 patients and 3 biopsies were negative for cancer. One patient developed a severe hypertensive crisis due to accidental thermal injury of the adrenal gland. An arterioportal fistula without active bleeding was noted in the CT scan after the procedure in another patient and it was treated with embolization. During a mean follow-up of 10 months (range 0.5-24) there was no evidence of tumor seeding by serial imaging in any patient. Three patients died. Causes of death were renal failure, pneumonia and complications of liver transplant 2,10 and 20 months respectively after the ablation. Sixteen patients are alive with various tumor responses to the ablations. Large core coaxial needle biopsy during MWA of HCC is a safe and effective method to obtain tissue for histological analyses and biorepository studies.