Acta Radiol OnlineFirst, published on April 6, 2016 as doi:10.

1177/0284185116639765

Original Article
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Determination of the electrical 2016
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DOI: 10.1177/0284185116639765
impact on therapy planning in the acr.sagepub.com

radiofrequency ablation of liver tumors

Urte Zurbuchen, Franz Poch, Ole Gemeinhardt, Martin E Kreis,

Stefan M Niehues, Janis L Vahldieck and Kai S Lehmann

Abstract
Background: Radiofrequency ablation is used to induce thermal necrosis in the treatment of liver metastases. The
specific electrical conductivity of a liver metastasis has a distinct influence on the heat formation and resulting tumor
ablation within the tissue.
Purpose: To examine the electrical conductivity s of human colorectal liver metastases and of tumor-free liver tissue in
surgical specimens.
Material and Methods: Surgical specimens from patients with resectable colorectal liver metastases were used for
measurements (size of metastases <30 mm). A four-needle measuring probe was used to determine the electrical
conductivity s of human colorectal liver metastasis (n ¼ 8) and tumor-free liver tissue (n ¼ 5) in a total of five patients.
All measurements were performed at 470 kHz, which is the relevant frequency for radiofrequency ablation. The tissue
temperature was also measured. Hepatic resections were performed in accordance with common surgical standards.
Measurements were performed in the operating theater immediately after resection.
Results: The median electrical conductivity s was 0.57 S/m in human colorectal liver metastases at a median tempera-
ture of 35.1 C and 0.35 S/m in tumor-free liver tissue at a median temperature of 34.9 C. The electrical conductivity was
significantly higher in tumor tissue than in tumor-free liver tissue (P ¼ 0.005). There were no differences in tissue
temperature between the two groups (P ¼ 0.883).
Conclusion: The electrical conductivity is significantly higher in human colorectal liver metastases than in tumor-free
liver tissue at a frequency of 470 kHz.

Keywords
Electrical conductivity, radiofrequency ablation, liver metastases
Date received: 26 October 2015; accepted: 17 February 2016

Introduction
Biological tissues have different electrical conductivities
Radiofrequency ablation (RFA) is a frequently used (6,7). Haemmerich et al. measured the electrical con-
treatment for primary liver tumors and liver metastases ductivity of a small number of human liver tumors
(1,2). A challenge in RFA is the induction of ablation and healthy liver tissue. They showed that the electrical
zones large enough to destroy the tumor tissue with an
adequate security margin to prevent local tumor recur-
rence. The mechanisms by which tissue is destroyed by Charité–Universitätsmedizin Berlin, Berlin, Germany
RFA are well known (3,4). The area of the induced
Corresponding author:
thermal necrosis is significantly influenced by the prop- Urte Zurbuchen, Charité–Universitätsmedizin Berlin, Campus Benjamin
erties of the treated tissue, such as blood flow in Franklin, Hindenburgdamm 30, Berlin, 12200, Germany.
the tissue (5) and its electrical conductivity (6). Email: urte.kunz-zurbuchen@charite.de

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conductivity is higher in tumor tissue than in healthy accordance with common surgical standards. The
tissue, independent of the frequency used for measure- measurements were obtained in the operating room
ment. Any relationship between temperature and elec- immediately (3–5 min) after resection of the surgical
trical conductivity was not examined in this study (8). specimen.
In an earlier study, we examined the changes in elec- The four-needle measuring probe was positioned in
trical conductivity s during tissue coagulation at the the tumor (Figs. 1 and 2), and the electrical conductiv-
ablative and cooling temperatures associated with ity was read from the measurement bridge. The
RFA (9). We used porcine liver tissue in an ex vivo temperature of the tissue was measured with a digital
model for this study. We showed that the electrical thermometer in the middle of the tissue near the mea-
conductivity increased during the heating phase and suring probe. Measurements in macroscopic tumor-
decreased continuously during the cooling phase. In a free liver tissue were performed in a similar manner
pre-test, we completed a single conductivity measure- within the same surgical specimen. The surgical speci-
ment in a human liver sample to examine the electrical mens underwent a histological assessment after
conductivity in healthy human liver tissue and in a measurement.
human liver metastasis. This measurement indicated All data (tissue temperature, electrical conductivity,
that the electrical conductivity of human liver tissue is histological findings, and pre-treatment chemotherapy)
significantly different from that of porcine liver tissue. were collected in a database. Statistical analyses were
The conductivity was higher for the liver metastasis and
lower for the healthy liver tissue compared with the
corresponding values in the porcine liver at the same
temperature.
The aim of this study was to examine the electric
conductivity s of human colorectal liver metastases
and of tumor-free liver tissue in surgical specimens.

Material and Methods

A wide-band 42 Hz to 5 MHz LCR (inductance,
capacitance, resistance) measurement bridge (LCR
HiTESTER 3532-50, Hioki Corporation, Ueda,
Nagano, Japan) with a four-needle measuring probe
was used to determine the electrical conductivity of
tissue samples. The physical principle of this measure-
ment is based on a model consisting of layers of air,
saline solution, and agar to simulate resistance within Fig. 1. Experimental set-up: LCR-measurement bridge
the tissue (10). This method minimizes the effects of (background left) with the measurement probe. The four-needle
polarization impedance and is commonly used in measurement probe is positioned within the tumor-free liver
tissue studies (11,12). The conductivity measurement tissue in this example. The digital thermometer (right) was used
for temperature measurement directly after the conductivity
system used in this study is described in detail by Tsai
measurement was performed.
et al. (12). In all the experiments, calibration was per-
formed with a physiological saline solution at a tem-
perature of 25 C. All measurements were performed at
470 kHz, which is the relevant frequency for RFA. We
used a small four-needle measuring probe for this study
to perform measurements in small tissue samples. The
minimum tissue diameter for this probe was 20 mm.
Surgical specimens from patients with resectable
colorectal liver metastases were used for measurements.
The inclusion criteria were resectable colorectal liver
metastases with a minimum diameter of 30 mm for a
single metastasis. Patients received detailed information
on the purpose of this study, and their written consent
was obtained. The study was approved by the Ethics
Commission of the Charité–University Medicine Berlin Fig. 2. Conductivity measurement in a colorectal liver
(EA4/020/11). Hepatic resections were performed in metastasis.

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Zurbuchen et al. 3

performed with IBM SPSS Statistics version 21 (IBM, electrical conductivity value was 0.35 S/m in the tumor-
Ehningen, Germany). Central tendencies were calcu- free liver tissue. The electric conductivity was signifi-
lated as medians (minimum – maximum) because cantly higher in the metastases than in the tumor-free
none of the parameters measured showed normal dis- liver tissue (Table 2).
tributions. The Mann–Whitney U Test was used for To examine whether a correlation between tempera-
comparisons between two independent groups. The ture and conductivity existed, we used Pearson’s correl-
level of significance was 0.05 (two-sided) for each stat- ation coefficient. The temperature difference was 2.1 C
istical test. To determine whether a linear correlation for liver metastases and 1 C for tumor-free liver tissue.
existed between temperature and conductivity, we used There was no significant correlation between tempera-
Pearson’s correlation coefficient. ture and conductivity in liver metastases or tumor-free
liver tissue (Pearson’s correlation: P ¼ 0.985 for liver
metastases and P ¼ 0.880 for tumor-free liver tissue).
Results
The measurements were obtained from human colorec-
tal liver metastases from five patients with a total of
Discussion
eight metastases. Measurements were also performed In this study, we examined the electrical conductivity s
in tumor-free liver tissues from all surgical specimens. in human colorectal liver metastases and in tumor-free
Table 1 shows the results of all electrical conductivity liver tissues from surgical specimens. We investigated
s measurements, including the temperature at the eight metastases in five patients. The median electrical
time of measurement. The postoperative histological conductivity s was 0.57 S/m at a median temperature of
examination confirmed colorectal adenocarcinomas 35.1 C for the metastases. This value was significantly
in all metastases. The tumor-free liver tissue samples higher than the electrical conductivity of the human
showed different grades of steatosis or fibrosis. The tumor-free liver tissue, which was 0.35 S/m at a tem-
measurements in all eight metastases were performed perature of 34.9 C.
at a median temperature of 35.1 C. The median elec- Previous studies in various tumor models suggested
trical conductivity s of the metastases was 0.57 S/m. that malignant tissue has a higher electrical conductiv-
The five measurements in healthy liver tissue were per- ity than normal tissues at radiofrequencies (11,13,14).
formed at a median temperature of 34.9 C. The median Haemmerich et al. measured electrical conductivity in a

Table 1. Electrical conductivity in colorectal liver metastases and tumor-free liver tissue.

Patient Age Temperature Specific electric

no. (years) Gender ( C) conductivity s (S/m) Histology

1 60 M Metastasis 1 37.2 0.62 Moderately differentiated

Metastasis 2 32.7 0.68 colorectal adenocarcinoma
Tumor-free 35.9 0.35 Severe mixed vesicular steatosis,
liver tissue moderate fibrosis
2 86 M Metastasis 34.0 0.44 Necrotic metastasis of a
colorectal adenocarcinoma
Tumor-free 33.9 0.26 Normal liver tissue
liver tissue
3 68 F Metastasis 1 32.5 0.51 Moderately differentiated
Metastasis 2 32.5 0.60 colorectal adenocarcinoma
Tumor-free 34.9 0.38 Marginal steatosis and fibrosis
liver tissue
4 59 F Metastasis 1 37.0 0.57 Moderately differentiated
Metastasis 2 36.1 0.56 colorectal adenocarcinoma
Tumor-free 34.6 0.46 Normal liver tissue
liver tissue
5 53 M Metastasis 36.1 0.54 Necrotic metastasis of a
colorectal adenocarcinoma
Tumor-free 35.9 0.32 Marginal steatosis and fibrosis
liver tissue

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Table 2. Statistical analysis of conductivity and temperature (two-sided Mann–Whitney U test).

Group

Colorectal liver metastases Tumor-free liver tissue

Median Minimum Maximum Median Minimum Maximum P

Specific electrical 0.57 0.44 0.68 0.35 0.26 0.46 0.005

conductivity s (S/m)
Temperature ( C) 35.1 32.5 37.2 34.9 33.9 35.9 0.883

small number of human liver tumors and healthy liver the measurements were essentially performed at body
tissue samples. These authors showed that the electrical temperature. Cell disintegration could be excluded, as
conductivity is higher in tumor tissue than in healthy all measurements were performed without delay after
tissue, independent of the frequency used for measure- resection.
ment (8). The relationship between temperature and However, this study also had some limitations. In
electrical conductivity was not examined in this study. addition to the small sample size, we measured the con-
In this study, the measurements were performed ductivity in liver tissue at only one specific temperature
30–60 min after resection of the surgical specimen and after surgical resection. Therefore, we could not exam-
after the transport of tissues to the pathology lab, ine temperature-dependent changes, which we expect to
where the tumor was centrally sliced to expose the occur during RFA. While these data would be interest-
tumor core. Haemmerich determined the electrical con- ing, such an approach is limited due to ethical consid-
ductivity to be 0.50 S/m for tumor tissue and 0.26 S/m erations. An experimental conductivity measurement
for normal liver tissue at 460 kHz. The temperature of involving the coagulation process would require heat-
the tissue upon measurement was not indicated. Our ing of the tumor (9), which would render a proper
results at 470 kHz, which were 0.57 S/m for tumor tis- pathological investigation impossible. The vasculariza-
sues and 0.35 S/m for normal liver tissue, are slightly tion of tissue was missing in our study. It is known that
higher than the values obtained by Haemmerich. Our the vascular perfusion of tissue has a high impact on its
results confirm that the electrical conductivity is higher biophysiological properties (5). The absence of blood
in tumor tissue than in normal tumor-free tissue. We flow in the measured tissue presumably influences the
assumed that the slightly greater electrical conductivity electrical conductivity. In our previous study, we
in our study was due to the higher temperature in the showed temperature-dependent changes in electrical
tissue at the time of measurement. In our experimental conductivity during the complete heating and cooling
set-up, the measurements were performed 3–5 min after phases within the RFA temperature range. We used
resection of the surgical specimen in the operating porcine liver samples for these ex vivo measurements.
room, and the tissue temperature was measured. In the present study, the temperature difference was
Empirical surgical specimens cool down quickly, 2.1 C for the liver metastases and 1 C for the tumor-
so we assume that the tissue temperatures in free liver tissue. There was no significant correlation
Haemmerich’s study were lower. between temperature and conductivity in our study.
In a previous study on porcine liver ex vivo, we Even if we did not examine the changes in electrical
determined that the electrical conductivity changes conductivity in human liver metastases during the
during the coagulation process (9). We showed that RFA heating and cooling phases for the reasons out-
the electrical conductivity s depends on the tissue tem- lined above, we assumed that the trends would be the
perature and that the conductivity continuously same and that the electrical conductivity would increase
increases during the thermal coagulation process. The during the heating phase and decrease continuously
maximum conductivity was reached at a temperature of during the cooling phase. Other experimental studies
80 C. During the cooling phase, which follows coagu- support this statement (15).
lation, the electrical conductivity was uniformly lower The heat dispersion during RFA of colorectal liver
than that during tissue heating. To our knowledge, no metastases is influenced by several application param-
data exist regarding the correlation between electrical eters (applicator length, power settings, application
conductivity s and tissue temperature in human colo- time), as well as by tissue-dependent parameters
rectal liver metastases. (16,17). In addition to vascular perfusion (5), electrical
All measurements were performed in the operating conductivity determines the depth of the heat disper-
room immediately after surgical resection to ensure that sion in the target tissue. Several studies have shown that

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Zurbuchen et al. 5

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