We read with interest the article by N'Kontchou et al.1 concerning hepatocellular carcinoma treatment by radiofrequency ablation (RFA). They report an excellent series with impressive results in terms of both very low major complication and tract seeding rates as well as a considerable long-term survival. Their complete response rate is 94.7%. However, this was assessed by radiological methods (magnetic resonance imaging and computed tomography) and not by pathological examination. As a result, the true response rate could be lower.
Our modest experience with 30 hepatocellular carcinoma nodules treated by RFA before liver transplant was recently published.2 We performed a pathological analysis of the explanted liver and found that only 14 nodules (46.7%) showed complete tumor destruction. In our study, the detection of RFA incomplete response by means of computed tomography scan had a 50% sensitivity and 100% specificity. The reported rates of complete pathological response in other works were variable but lower than those reported by N'Kontchou et al.: 20%,3 34.2%,4 37.5%,5 46.7%,6 55%,7 70.3%,8 and 75%.9 In these studies, as in ours, pathological examination was performed using hematoxylin-eosin stains.
Although RFA cannot be considered as a radical or curative treatment, and the ideal situation would be complete tumor destruction, partial destruction is probably enough to increase long-term survival and, especially, to avoid patient drop-out from liver transplant waiting lists.