Efficacy and Safety of Fusion Imaging in Radiofrequency Ablation of Hepatocellular Carcinoma Compared to Ultrasound: A Meta-Analysis

Background: Radiofrequency ablation (RFA), generally performed under real-time guidance of ultrasound which is safe and effective, is a common minimally invasive therapy for treating hepatocellular carcinoma. Fusion imaging (FI) is a newly developed imaging method, which integrates CT/MRI accurate imaging and matches the characteristics of real-time ultrasound imaging, thereby providing a new approach to guide tumor ablation therapy. However, the efficacy and safety of FI as opposed to ultrasound in tumor ablation remains unclear. Objective: The present study sought to evaluate the difference in the efficacy and safety between FI and ultrasound in radiofrequency surgery for the treatment of hepatocellular carcinoma through a metaanalysis. Materials and Methods: Searching for studies comparing the efficacy and safety of FI and ultrasound in radiofrequency of hepatocellular carcinoma in PubMed, Embase, and Cochrane Library databases for articles published until April 2021. Random or fixed effect models were used for statistical analysis. Metaanalysis and sensitivity analysis were used on the included studies. Results: A total of six studies met predefined inclusion criteria, and were finally included in the analysis. Sensitivity and subgroup analyses, based on predetermined patient characteristics, allowed minimization of bias. In the RFA of hepatocellular carcinoma, FI decreased 1-year overall survival (OS) when compared with ultrasound. But FI was not significantly different from ultrasound in terms of technical efficiency, 1-, 2-, and 3-year local tumor progression (LTP), complications, as well as 2-year OS. Subgroup analysis, based on tumor mean diameter, showed that FI reduced the rate of 1- and 2-year LTP in patients with tumors of mean diameter ≥15 mm when compared with ultrasound. Moreover, operative complications could be reduced in patients with tumor mean diameter <15 mm using FI, compared with ultrasound. Conclusion: Overall, these results showed that FI may have some effects on improving efficacy and safety of thermal ablation in HCC patients, relative to ultrasound. However, it may be a more effective method for managing large lesions, as well as those that are difficult to ablate. Further large-scale and well-designed randomized controlled trials are needed to validate these findings.