Real-Life Clinical Use and Outcomes of Fusion Imaging Guided Percutaneous Microwave Ablation of Hepatocellular Carcinoma: Experience from Two Italian Centres

Background: Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. Percutaneous thermal ablation is an effective treatment, but standard ultrasound (US) guidance is limited in cases of inconspicuous nodules. Ultrasound fusion imaging (USFI), which overlays cross-sectional imaging onto real-time U is an emerging tech-nique which improves tumor visibility and technical feasibility. This study reports re-al-life outcomes of USFI-guided microwave ablation (MWA) for HCC in two Italian centres. Materials and Methods: In this multicentric retrospective study, 56 patients with 73 poorly or non-visible HCC nodules underwent USFI-guided percutaneous MWA with no visibility or poor visi-bility on B-mode US. Technical success, complications, and local tumor control were evaluated, with follow-up imaging at 1 month and every 3 months thereafter. Results: Complete response (CR) at 1 month was observed in 78.1% of nodules, with residual disease (RD) more common in poorly visible nodules than non-visible nodules (18.1% vs. 4.2%, p=0.019). During a median 13-month follow-up, local tumor progression (LTP) occurred in 9.6% of patients. No significant association was found with difficult tumor location. Conclusion: USFI-guided MWA is a safe and effective option for treating HCC nodules not ade-quately visualized with conventional US, expanding eligibility to complex cases.