BACKGROUND:Interventional radiology (IR) procedures may induce anti-tumor immune responses, with subsequent clonal expansion of specific T-cells recognizing tumor antigens. This exploratory study aims to investigate the clonal expansion of T-cells in the peripheral blood after interventional radiology procedures for metastatic liver cancer. METHODS:This prospective study included 16 patients with metastatic liver cancer undergoing IR procedures (13 embolizations and 3 ablations). Biopsy samples were collected prior to the procedure, and peripheral blood samples were obtained both pre- and post-procedure. Bulk T-cell receptor (TCR) sequencing was conducted to assess T-cell clonality dynamics and to evaluate the impact of procedures on the T-cell repertoire. RESULTS:The overall clonality of the T-cell repertoire in the peripheral blood did not demonstrate significant variations following IR procedures (p = 0.27-0.77). A subset of patients exhibited limited T-cell clonal expansion in peripheral blood one month after IR procedures, with more than 10 T-cell clonotypes expanding in 43% of patients. Most clonal expansions decreased in frequency by three months; however, 3 patients displayed persistently expanding T-cell clonotypes in peripheral blood ≥ 3 months following IR procedures. CONCLUSIONS:IR procedures do not alter the overall clonality of the T-cell repertoire but may promote the expansion of a limited number of clonotypes. This study demonstrates that it is feasible to detect and longitudinally track expanding T-cell clonotypes following IR liver-directed therapy. Further studies are needed to determine whether these expanding clonotypes contribute to systemic anti-tumor immunity.

BACKGROUND:Hepatic artery infusion pump (HAIP) chemotherapy is a locoregional treatment for intrahepatic malignancies. HAIPs are surgically implanted, and the catheter tip is typically inserted into a ligated gastroduodenal artery stump. Potential complications at the catheter insertion site include dehiscence, pseudoaneurysm or extravasation, and adjacent hepatic arterial stenosis and thrombosis. Bleeding complications can be treated with stent-graft placement or coil embolization across the injury site, typically with standard antegrade arterial approach into the hepatic arterial system by transfemoral or transradial access. However, in cases where an antegrade approach is not possible, alternative methods are necessary. CASE PRESENTATION:A patient presented with an enlarging hematoma due to bleeding at the gastroduodenal artery HAIP catheter insertion site. Emergent angiography revealed concomitant common hepatic artery occlusion and retrograde perfusion of the GDA via tortuous, diminutive hepatic collaterals which precluded standard antegrade approach. Collateral inflow from the dorsal pancreatic artery was utilized to opacify the right hepatic artery. The segment 5 hepatic artery was percutaneously accessed under fluoroscopic guidance, and microcoils were deployed both proximal and distal to origin of the gastroduodenal artery. The patient remained stable throughout the postoperative period and was discharged after an otherwise uneventful admission. Follow-up computed tomography demonstrated resolution of the hematoma and no bleeding or biliary complication from transhepatic access. CONCLUSIONS:This report highlights the safety and efficacy of percutaneous transhepatic arterial access for endovascular management of HAIP associated bleeding at the gastroduodenal artery when standard antegrade interventions cannot be performed. Interventional radiologists caring for patients with HAIPs should be familiar with their potential complications and the range of techniques required for management.

The aim of this study was to evaluate associations between TP53 status and outcomes after transarterial embolization (TAE) for the treatment of patients with hepatocellular carcinoma (HCC). This single-institution study included patients from 1/2014 to 6/2022 who underwent TAE of HCC and genomic analysis of tumoral tissue. The primary outcome was overall survival (OS) with relation to TP53 status, and the secondary outcome was the time to progression. Survival analysis was performed using the Kaplan–Meier method. The time to progression with death or the last patient contact without progression as competing risks were used to obtain a cumulative incidence function, and the association with TP53 status was evaluated using the Gray test. In total, 75 patients (63 men) with a median age of 70.0 (IQR 62.0–76.3) years were included. Of these, 26/75 (34.7%) patients had TP53-mutant HCC. Patients with TP53-mutant HCC had a significantly worse median OS of 15.2 (95% CI, 9.5–29.3) months, versus 31.2 (95% CI, 21.2–52.4) months as the median OS (p = 0.023) for TP53 wild-type HCC. Competing risk analysis showed a shorter time to local hepatic progression (at the site of the previously treated tumor) after TAE in patients with TP53-mutant HCC. The cumulative incidences of local progression at 6 and 12 months for TP53-mutant HCC were 65.4% and 84.6%, versus 40.8% and 55.1% for TP53 wild-type HCC (p = 0.0072). A TP53 mutation may predict a worse overall survival and a shorter time to local progression in HCC patients treated with TAE.

The current guidelines for the treatment of extrathoracic metastases secondary to thymic neoplasms recommend chemotherapy. Thymic carcinomas are radiosensitive, and radiation therapy is recommended for intrathoracic masses and isolated metastases that are not amenable to resection. Liver-directed therapy, particularly yttrium-90 radioembolization, has been used for the treatment of oligometastatic diseases in the liver from various primaries. Here, we report three cases of radioembolization for the treatment of thymic carcinoma that metastasized to the liver.

A growing number of centers offer hepatic artery infusion pump (HAIP) chemotherapy for advanced liver malignancies. While small series have demonstrated feasibility of robotic HAIP placement, comparison of outcomes with open placement is lacking. We compared outcomes after robotic versus open HAIP placement. We retrospectively reviewed HAIP placement without concurrent hepatectomy at Memorial Sloan Kettering Cancer Center from 1 January 2011 to 15 September 2022, and Duke Health from 1 November 2018 to 18 May 2023. Patients with prior liver surgery or who required catheterization of a non-standard vessel were excluded. Propensity score matching weights (PSMW) were calculated using age, sex, race, body mass index, American Society of Anesthesiologists class, neoadjuvant chemotherapy, colorectal procedure, and institution. Survey-weighted generalized linear models assessed the relationship between approach and outcomes. Of 2002 consecutive HAIP placements, 819 (645 open/174 robotic) met the inclusion criteria. A higher proportion of open procedures involved combined colorectal procedures; other patient characteristics were similar. Overall, 15

PURPOSE:To assess and compare the safety, effectiveness, and outcomes of transarterial hepatic embolization (TAE) and transarterial radioembolization (TARE) for the treatment of patients with unresectable hepatocellular carcinoma (HCC) >7 cm. MATERIALS AND METHODS:Treatment-naive patients with HCC >7 cm who were treated with TAE or TARE between January 2013 and December 2023 were reviewed in this retrospective study. Nearest neighbor 2:1 propensity score matching was utilized for direct comparison. Radiological treatment response was assessed using the modified Response Evaluation Criteria in Solid Tumours (mRECIST). Kaplan-Meier survival curves were used to estimate progression-free survival (PFS) and overall survival (OS). Log-rank tests were performed to compare survival curves. RESULTS:A total of 125 patients with HCC >7 cm were treated with TAE (n = 103) or TARE (n = 22). After propensity score matching, 44 patients who underwent TAE and 22 patients who were treated with TARE were compared. The mean tumor sizes were 10.4 cm (SD ± 2.6) in the TAE group and 10.7 cm (SD ± 2.7) in the TARE group (P > .695). TAE and TARE exhibited comparable adverse event (AE) rates (Grade 1 AE in 22 [50%] of 44 in TAE and 6 [27%] of 22 in TARE, P = .999; 1 Grade 2 AE [4.5%] in TAE). Median OS durations were 15.2 and 23.6 months in the TAE and TARE groups, respectively (P = .252). Median local PFS (4.7 vs 21.6 months, P < .001) and PFS (3.6 vs 10.0 months, P = .002) were significantly longer after TARE. TAE and TARE had similar objective response rates (TAE, 88.6% vs TARE, 77.3%; P = .364). Systemic therapy after TAE or TARE was a significant positive prognostic factor associated with freedom from disease progression and survival (PFS hazard ratio [HR], 0.58 [P = .047]; OS HR, 0.33 [P < .001]). CONCLUSIONS:TAE and TARE are both safe transarterial therapies for patients with HCC >7 cm. TARE is associated with a longer time to progression and longer OS.

Background:This article aims to present the single-institution outcomes of patients with Fibrolamellar Carcinoma (FLC) treated with liver-directed therapies (LDT). Methods:In this single-center retrospective study, all patients diagnosed with FLC who underwent LDT were identified. Between July 2012 and July 2023, six patients were identified. One patient was excluded due to bleeding. Demographic and clinical parameters were recorded. Complications within 30 days of the LDT were evaluated. Radiological treatment responses at 1, 6, and 12 months were assessed per mRECIST. Results:A total of five patients, which included three females and two males, were reviewed. Three patients were treated with transarterial hepatic embolization (TAE; n = 3), transarterial radioembolization (TARE; n = 1), and combined TAE + radiofrequency ablation (n = 1). The objective response rate at one month was 80% [CR = 2 (40%), PR = 2 (40%), and SD = 1 (20%)]. At 12 months (n = 4), two patients demonstrated CR (50%) and two demonstrated PR (50%). Overall survival from LDT at five years was 50%. There was no 30-day mortality among this group of patients or any adverse event attributable to the LDT. Conclusion:TAE, TARE, and ablation are safe and effective therapeutic options for FLC. Based on this study and previously published case reports, ablation and TARE yielded the most favorable results.

AIMS:To evaluate the ability of logistic regression and machine learning methods to predict active arterial extravasation on computed tomographic angiography (CTA) in patients with acute gastrointestinal hemorrhage using clinical variables obtained prior to image acquisition. MATERIALS AND METHODS:CT angiograms performed for the indication of gastrointestinal bleeding at a single institution were labeled retrospectively for the presence of arterial extravasation. Positive and negative cases were matched for age, gender, time period, and site using Propensity Score Matching. Clinical variables were collected including recent history of gastrointestinal bleeding, comorbidities, laboratory values, and vitals. Data were partitioned into training and testing datasets based on the hospital site. Logistic regression, XGBoost, Random Forest, and Support Vector Machine classifiers were trained and five-fold internal cross-validation was performed. The models were validated and evaluated with the area under the receiver operating characteristic curve. RESULTS:Two-hundred and thirty-one CTA studies with arterial gastrointestinal extravasation were 1:1 matched with 231 negative studies (N=462). After data preprocessing, 389 patients and 36 features were included in model development and analysis. Two hundred and fifty-five patients (65.6%) were selected for the training dataset. Validation was performed on the remaining 134 patients (34.4%); the area under the receiver operating characteristic curve for the logistic regression, XGBoost, Random Forest, and Support Vector Machine classifiers was 0.82, 0.68, 0.54, and 0.78, respectively. CONCLUSION:Logistic regression and machine learning models can accurately predict presence of active arterial extravasation on CTA in patients with acute gastrointestinal bleeding using clinical variables.

AIMS:Structured reporting in pathology is not universally adopted and extracting elements essential to research often requires expensive and time-intensive manual curation. The accuracy and feasibility of using large language models (LLMs) to extract essential pathology elements, for cancer research is examined here. METHODS:Retrospective study of patients who underwent pathology sampling for suspected hepatocellular carcinoma and underwent Ytrrium-90 embolisation. Five pathology report elements of interest were included for evaluation. LLMs (Generative Pre-trained Transformer (GPT) 3.5 turbo and GPT-4) were used to extract elements of interest. For comparison, a rules-based, regular expressions (REGEX) approach was devised for extraction. Accuracy for each approach was calculated. RESULTS:88 pathology reports were identified. LLMs and REGEX were both able to extract research elements with high accuracy (average 84.1%-94.8%). CONCLUSIONS:LLMs have significant potential to simplify the extraction of research elements from pathology reporting, and therefore, accelerate the pace of cancer research.

The aim of this study was to evaluate outcomes of transarterial radioembolization (TARE) for hepatocellular carcinoma (HCC) in patients previously treated with transarterial embolization (TAE). In this retrospective study, all HCC patients who received TARE from 1/2012 to 12/2022 for treatment of residual or recurrent disease after TAE were identified. Overall survival (OS) was estimated using the Kaplan–Meier method. Univariate Cox regression was performed to determine significant predictors of OS after TARE. Twenty-one patients (median age 73.4 years, 18 male, 3 female) were included. Median dose to the perfused liver volume was 121 Gy (112–444, range), and 18/21 (85.7%) patients received 112–140 Gy. Median OS from time of HCC diagnosis was 32.9 months (19.4–61.4, 95% CI). Median OS after first TAE was 29.3 months (15.3–58.9, 95% CI). Median OS after first TARE was 10.6 months (6.8–27.0, 95% CI). ECOG performance status of 0 (p = 0.038), index tumor diameter < 4 cm (p = 0.022), and hepatic tumor burden < 25% (p = 0.018) were significant predictors of longer OS after TARE. TARE may provide a survival benefit for appropriately selected patients with HCC who have been previously treated with TAE.

Purpose: Evaluate safety and feasibility of simultaneous biliary drainage (BD) and portal vein embolization (PVE) prior to hepatectomy in hilar cholangiocarcinoma (HCCA) patients. Methods: From January 2010 to June 2022, patients with potentially surgically resectable HCCA who underwent preoperative PVE and BD were analyzed. Type of initial BD, time interval between BD and PVE, changes in future liver remnant (FLR), time interval between BD, PVE and resection, and complications were recorded. Patients were divided into 3 groups based on the BD-PVE interval: Group A: simultaneous BD and PVE or within 7 days (d), n = 6; Group B: d ≥ 7 to ≤ 30, n = 7; Group C: d > 30, n = 14). Primary endpoints were post-PVE complications, FLR change, and resection rate. Secondary endpoints were Clavien-Dindo ≥ 3, Grade B/C Post Hepatectomy Liver Failure (PHLF) and 90 days mortality rate. Results: A total of 27 patients (mean age = 64.4 +/- 11.2 years) underwent both BD and PVE prior to hepatectomy. Mean degree of hypertrophy at 4-6 weeks post-PVE was 10.4 +/- 3.7% with no significant difference between the 3 groups (p > 0.05). Resection was 67% in Group A, and 57% and 36% in groups B and C respectively (p < 0.05). Time to surgery was 38.5 +/- 12 days in Group A, and 60 and 147 days in groups B and C respectively (p = 0.002). No major post PVE SIR complication was reported in group A. Overall rate of Grade III/IV Clavien-Dindo complication was 61.5% with no difference among the three groups (50%, 75%, and 60%; groups A, B and C, respectively). Overall PHLF Grade B/C was reported in 46.2% of patients. No patients in Group A demonstrated Grade B/C PHLF. Conclusion: Simultaneous BD and PVE is safe and reduces the time to surgery, which may help contribute to a higher rate of surgical resection.

This study aims to assess the effectiveness of integrating Segment Anything Model (SAM) and its variant MedSAM into the automated mining, object detection, and segmentation (MODS) methodology for developing robust lung cancer detection and segmentation models without post hoc labeling of training images. In a retrospective analysis, 10,000 chest computed tomography scans from patients with lung cancer were mined. Line measurement annotations were converted to bounding boxes, excluding boxes < 1 cm or > 7 cm. The You Only Look Once object detection architecture was used for teacher-student learning to label unannotated lesions on the training images. Subsequently, a final tumor detection model was trained and employed with SAM and MedSAM for tumor segmentation. Model performance was assessed on a manually annotated test dataset, with additional evaluations conducted on an external lung cancer dataset before and after detection model fine-tuning. Bootstrap resampling was used to calculate 95% confidence intervals. Data mining yielded 10,789 line annotations, resulting in 5403 training boxes. The baseline detection model achieved an internal F1 score of 0.847, improving to 0.860 after self-labeling. Tumor segmentation using the final detection model attained internal Dice similarity coefficients (DSCs) of 0.842 (SAM) and 0.822 (MedSAM). After fine-tuning, external validation showed an F1 of 0.832 and DSCs of 0.802 (SAM) and 0.804 (MedSAM). Integrating foundational segmentation models into the MODS framework results in high-performing lung cancer detection and segmentation models using only mined clinical data. Both SAM and MedSAM hold promise as foundational segmentation models for radiology images.

PURPOSE:To compare the effectiveness of percutaneous lung biopsy using a patient-mounted needle-driving robotic system with that using a manual insertion of needles under computed tomography (CT) fluoroscopy guidance. MATERIALS AND METHODS:In this institutional review board approved study, the cohort consisted of a series of patients who underwent lung biopsies following the intention-to-treat protocol from September 2022 to September 2023 using robot (n = 15) or manual insertion under single-rotation CT fluoroscopy (n = 66). Patient and procedure characteristics were recorded as well as outcomes. RESULTS:Although age, body mass index, and skin-to-target distance were not statistically different, target size varied (median, 8 mm [interquartile range, 6.5-9.5 mm] for robot vs 12 mm [8-18 mm] for single-rotation CT fluoroscopy; P = .001). No statistical differences were observed in technical success (86.7% [13/15] vs 89.4% [59/66], P = .673), Grade 3 adverse event (AE) (6.7% [1/15] vs 12.1% [8/66], P = .298), procedural time (28 minutes [22-32 minutes] vs 19 minutes [14.3-30.5 minutes], P = .086), and patient radiation dose (3.9 mSv [3.2-5.6 mSv] vs 4.6 mSv [3.3-7.5 mSv], P = .398). In robot-assisted cases, the median angle out of gantry plane was 10° (6.5°-16°), although it was null (0°-5°) for single-rotation CT fluoroscopy (P = .001). CONCLUSIONS:Robot-assisted and single-rotation CT fluoroscopy-guided percutaneous lung biopsies were similar in terms of technical success, diagnostic yield, procedural time, AEs, and radiation dose, although robot allowed for out-of-gantry plane navigation along the needle axis.

Objectives: This systematic review aims to assess existing research concerning the use of robotic systems to execute percutaneous lung biopsy. Methods: A systematic review was performed and identified 4 studies involving robotic systems used for lung biopsy. Outcomes assessed were operation time, radiation dose to patients and operators, technical success rate, diagnostic yield, and complication rate. Results: One hundred and thirteen robot-guided percutaneous lung biopsies were included. Technical success and diagnostic yield were close to 100%, comparable to manual procedures. Technical accuracy, illustrated by needle positioning, showed less frequent needle adjustments in robotic guidance than in manual guidance ( P < .001): 2.7 ± 2.6 (range 1-4) versus 6 ± 4 (range 2-12). Procedure time ranged from comparable to reduced by 35% on average (20.1 ± 11.3 minutes vs 31.4 ± 10.2 minutes, P = .001) compared to manual procedures. Patient irradiation ranged from comparable to reduced by an average of 40% (324 ± 114.5 mGy vs 541.2 ± 446.8 mGy, P = .001). There was no significant difference in reported complications between manual biopsy and biopsies that utilized robotic guidance. Conclusion: Robotic systems demonstrate promising results for percutaneous lung biopsy. These devices provide adequate accuracy in probe placement and could both reduce procedural duration and mitigate radiation exposure to patients and practitioners. However, this review underscores the need for larger, controlled trials to validate and extend these findings.

To assess the feasibility of utilizing a large language model (LLM) in extracting clinically relevant information from healthcare data in patients who have undergone microwave ablation for lung tumors. In this single-center retrospective study, radiology reports and clinic notes of 20 patients were extracted, up to 12 months after treatment. Utilizing an LLM (generative pretrained transformer 3.5 Turbo 16k), a zero-shot prompt strategy was employed to identify 4 key outcomes from relevant healthcare data: (a) recurrence at ablation site, (b) pneumothorax, (c) hemoptysis, and (d) hemothorax following ablation. This was validated with ground-truth labels obtained through manual chart review. Analysis of 104 radiology reports and 37 clinic notes was undertaken. The LLM output demonstrated high accuracy (85%-100%) across the 4 outcomes. An LLM approach appears to have utility in extraction of clinically relevant information from healthcare data. This method may be beneficial in facilitating data analysis for future interventional radiology studies.