Radiofrequency ablation of hepatocellular carcinoma

NICE interventional procedures guidance [IPG2] Published date:

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The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on the use of radiofrequency ablation for hepatocellular carcinoma.

NICE has issued guidance on radiofrequency ablation for the treatment of colorectal metastases in the liver, which can be found at www.nice.org.uk/IPG092. NICE has also produced guidance on microwave ablation for hepatocellular carcinoma (www.nice.org.uk/IPG214) and for the treatment of metastases of the liver (www.nice.org.uk/IPG220).

  • Description

    This is a minimally invasive treatment for liver tumours.  Hepatocellular carcinoma (HCC) and metastasis from colorectal carcinoma are the two most common malignant tumours to affect the liver. The annual incidence of HCC is estimated to be at least one per million. Untreated HCC has a median survival of four to six months from the time of diagnosis.

    Metastatic liver disease is frequently associated with primary colorectal carcinoma. Approximately 50% of colorectal cancer patients will develop recurrence within five years of initial diagnosis with the liver being the most common site for metastatic disease.

    This procedure is a recently developed thermoablative technique that induces temperature changes by utilising high-frequency alternating current applied via an electrode(s) placed within the tissue to generate ionic agitation. The ionic agitation is generated in the areas surrounding the electrode tip as the ions attempt to change directions and follow the alternating current, thereby creating localised friction heat. The resultant frictional heating of tissue surrounding the electrode generates localised areas of coagulative necrosis and tissue desiccation.

    The radiofrequency energy radiates from the individual electrodes into the adjacent tissue. The energy level and thus the heating effect dissipates rapidly at an increasing distance from the electrodes so that the highest temperature will always be at the points nearest to the electrodes. Radiofrequency ablation (RFA) can be applied percutaneously, laparoscopically or intraoperatively.

    The majority of malignant liver tumours remain inoperable due to their number, distribution and/or the presence of residual disease. Therefore, a number of alternative therapies have been developed including hepatic artery infusion chemotherapy (HAIC), as well as non-resectional chemotherapy, percutaneous ethanol injection (PEI), cryoablation, microwave coagulation therapy (MCT), laserinduced thermotherapy, and radiofrequency ablation.

     

  • OPCS4.6 Code(s)

    J12.4 Percutaneous radiofrequency ablation of lesion of liver

    Y53.- Approach to organ under image control

    Note: Codes within category Y53.-  are used as secondary codes to classify interventions that are percutaneous and require some form of image control: if the method of image control is unspecified, Y53.9 Unspecified approach to organ under image control is assigned.

    In addition the ICD-10 code C22.0 Liver cell carcinoma or C78.7 Secondary malignant neoplasm of liver and intrahepatic bile duct would be recorded.

    The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding

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