Laura Sophia Kupke

Objective: To evaluate the safety, diagnostic yield, and ablation efficacy of a single-session workflow combining stereotactic percutaneous core-needle biopsy (CNB) immediately followed by microwave ablation (MWA) for liver tumors. Methods: We retrospectively reviewed consecutive patients (December 2021–May 2025) who underwent stereotactic CNB followed by MWA in the same procedure. Primary endpoints were primary technique efficacy (PTE) and complications. Secondary endpoints were 6-month local tumor progression (LTP) and diagnostic yield. Six-month LTP was summarized using a Kaplan–Meier (KM) point estimate with Greenwood 95% CIs. Results: Thirty-three patients underwent single-session biopsy and ablation (33 biopsied; 41 lesions ablated). PTE was 95.1% (39/41); two residual tumors were successfully re-ablated. Six-month LTP was 3.6% (patient level; KM 95% CI 0.0–10.5%) and 2.8% (lesion level; KM 95% CI 0.0–8.2%). There was one major complication (3%, post-ablation abscess) and no minor complications. Adequate tissue was obtained in all biopsies; a definitive diagnosis was established in 88% (29/33): malignancy in 73% (24/33) and benignity in 15% (5/33); 12% (4/33) were nondiagnostic. In the hepatocellular carcinoma (HCC)-suspected subgroup (LI-RADS LR-3 to LR-5; n = 24), all LR-5 lesions were HCC (11/11). Among LR-4 lesions (n = 7), histology showed HCC in 1/7 (14%) and cholangiocarcinoma in 2/7 (29%); 4/7 (57%) were benign or nondiagnostic. Among LR-3 lesions (n = 6), 2/6 (33%) were HCC and 4/6 (67%) were benign or nondiagnostic. In the metastasis-suspected subgroup (n = 9), malignancy was confirmed in 8/9 (89%); 1/9 (11%) was nondiagnostic. Conclusions: Single-session stereotactic CNB followed by MWA is feasible and safe, yields diagnostically useful tissue, and achieves high ablation efficacy.

Aim: Aim of the study was to differentiate solid liver lesions according to their microvascularization. Therefore, we analyzed perfusion using time intensity curves (TIC) measured during contrast-enhanced intraoperative ultrasound (CE-IOUS). Material and Methods: Data of 40 patients who underwent hepatic surgery with the diagnosis of hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (CCC), or liver metastases (LM) were retrospectively collected. CE-IOUS was performed using a linear multifrequency T-probe connected to a high-resolution device. Digital Imaging and Communications in Medicine (DICOM) loops were recorded, and TIC were analyzed for time to peak (TTP) and area under the curve (AUC) in tumor center, margin and reference tissue. Results: Analyses of the tumor center revealed significant higher AUC in HCC lesions than in CCC ( p = 0.0310). HCC patients also showed longer TTP in reference tissue compared to CCC ( p = 0.0251). Within the HCC cohort, TTP was shorter at tumor margins compared to reference tissue ( p = 0.0420). For LM, AUC measured at tumor margins was higher than in center and reference tissue ( p _{center-margin} = 0.0266, p _{margin-reference} = 0.0064). Conclusion: TIC analysis of solid liver lesions during CE-IOUS revealed significant differences in their microvascularization, improving, intraoperative differentiation. Artificial intelligence tools may enhance IOUS in the future by standardization and motion compensation.

Soluble CD46 (sCD46) has recently been shown to be an effective biomarker of steatotic liver disease (SLD), which is highly prevalent in the western world. Since SLD directly affects outcomes after major hepatectomies and liver transplantation, accurate appraisal of this condition is crucial before liver surgery. In the present study, we asked whether sCD46 measurement in patient plasma could augment the pre-surgical prediction of SLD performed by contrast-enhanced computed tomography. Our data show that combined performance of these tests reveals an area under the curve for the prediction of high-grade SLD of 0.956. After cross-validation, our clinical score leads to an accuracy of 95.12% to detect severe steatosis. Therefore, sCD46 is a promising biomarker for optimizing pre-surgical decision-making assessments, with the aim to identify patients that could benefit from alternative treatment options.

OpenAI’s GPT-4V reliably identified the imaging modality and anatomic region but could not safely detect, classify, or rule out abnormalities on single MRI, CT, and radiographic images.

Background: The aim of this study was to evaluate the performance and the impact of contrast-enhanced intraoperative ultrasound (CE-IOUS) on intraoperative decision-making, as there is still no standardized protocol for its use. Therefore, we retrospectively analyzed multiple CE-IOUS performed in hepato-pancreatic-biliary surgery with respect to pre- and postoperative imaging and histopathological findings. Methods: Data of 50 patients who underwent hepato-pancreatic-biliary surgery between 03/2022 and 03/2024 were retrospectively collected. CE-IOUS was performed with a linear 6–9 MHz multifrequency probe connected to a high-resolution device. The ultrasound contrast agent used was a stabilized aqueous suspension of sulphur hexafluoride microbubbles. Results: In total, all 50 lesions indicated for surgery were correctly identified. In 30 cases, CE-IOUS was used to localize the primary lesion and to define the resection margins. In the remaining 20 cases, CE-IOUS identified an additional lesion. Fifteen of these findings were identified as malignant. In eight of these cases, the additional malignant lesion was subsequently resected. In the remaining seven cases, CE-IOUS again revealed an inoperable situation. In summary, CE-IOUS diagnostics resulted in a high correct classification rate of 95.7%, with positive and negative predictive values of 95.2% and 100.0%, respectively. Conclusions: CE-IOUS shows excellent performance in describing intraoperative findings in hepato-pancreatic-biliary surgery, leading to a substantial impact on intraoperative decision-making.

Cold atmospheric plasma (CAP) reduces bacteria and interacts with tissues and cells, thus improving wound healing. The CAP-related induction of neutrophils was recently described in stained sections of wound tissue in mice. Consequently, this study aimed to examine the functionality of human polymorphonuclear cells (PMN)/granulocytes through either a plasma-treated solution (PTS) or the direct CAP treatment with different plasma modes and treatment durations. PTS analysis yielded mode-dependent differences in the production of reactive oxygen species (ROS) and reactive nitrogen species (RNS) after CAP treatment. Live-cell imaging did not show any chemo-attractive or NETosis-inducing effect on PMNs treated with PTS. The time to maximum ROS production (T_maxROS) in PMNs was reduced by PTS and direct CAP treatment. PMNs directly treated with CAP showed an altered cell migration dependent on the treatment duration as well as decreased T_maxROS without inducing apoptosis. Additionally, flow cytometry showed enhanced integrin and selectin expression, as a marker of activation, on PMN surfaces. In conclusion, the modification of PMN immunoreactivity may be a main supporting mechanism for CAP-induced improvement in wound healing.