International multisociety Delphi consensus for liver tumour thermal ablation: margin assessment - 28/04/26
Doi : 10.1016/S1470-2045(26)00143-9
Iwan Paolucci, PhD a, *, Christiaan G Overduin, PhD b, *, Edward W Johnston, MD c, d, Gregor Laimer, MD PhD e, Muneeb Ahmed, ProfMD f, Ronald S Arellano, ProfMD g, Marie Beerman, MD h, Lukas P Beyer, ProfMD i, David J Breen, MD j, Mark C Burgmans, ProfMD k, Marco Calandri, ProfMD l, m, Ming-Chih Chern, MD n, Laura Crocetti, MD PhD o, Ronald M van Dam, MD PhD p, q, r, Alban Denys, Prof s, Bjørn Edwin, ProfMD PhD t, Dimitrios Filippiadis, ProfMD u, Yuman Fong, ProfMD v, Nicos Fotiadis, ProfMD c, d, Jacob Freedman, MD w, Åsmund A Fretland, MD t, Mariano Gimenez, ProfMD x, Rodrigo G Garcia, MD y, Rosario F Grasso, ProfMD z, Thomas K Helmberger, ProfMD aa, Pim Hendriks, MSc k, Roberto Iezzi, ProfMD ab, Sjoerd FM Jenniskens, MD b, Alexander Kupferthaler, MD ac, Anja Lachenmayer, MD ad, Fred T Lee, ProfMD ae, Jeong M Lee, ProfMD af, Susan van der Lei, MD ag, Christiaan van der Leij, MD ah, ai, Ping Liang, ProfMD aj, Charles C-W Lin, MD ak, Lukas Luerken, MD al, Manuel Maglione, MD am, Andreas Mahnken, ProfMD an, Justin P McWilliams, ProfMD ao, Marcos Menezes, ProfMD ap, Govindarajan Narayanan, ProfMD aq, Franco Orsi, ProfMD ar, Philippe L Pereira, ProfMD as, Uei Pua, ProfMD at, Robbert S Puijk, MD ag, Hyunchul Rhim, ProfMD au, William S Rilling, ProfMD av, Simeon J S Ruiter, MSc aw, Anthony G Ryan, MD ax, ay, az, Peter Schullian, MD e, Paul B Shyn, MD ba, Ajith K Siriwardena, ProfMD bb, Maarten L J Smits, MD bc, Constantinos T Sofocleous, ProfMD bd, Luigi Solbiati, ProfMD be, Vlasios Sotirchos, MD bd, Stefan Stättner, MD bf, bg, Marco van Strijen, MD bh, Trygve Syversveen, MD bi, Pascale Tinguely, MD bj, Lambros Tselikas, MD bk, Jean-Nicolas Vauthey, ProfMD bl, Thomas J Vogl, ProfMD bm, Tze M Wah, ProfMD bn, Sarah B White, ProfMD av, Philipp Wiggermann, MD bo, Bradford J Wood, ProfMD bp, Jan van der Meulen, ProfPhD bq, S Nahum Goldberg, ProfMD br, Martijn R Meijerink, ProfMD ag, Reto Bale, ProfMD e, †, ⁎ 
, Bruno C Odisio, ProfMD a, †
, Bruno C Odisio, ProfMD a, † a Department of Interventional Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
b Department of Medical Imaging, Interventional Radiology, Radboud University Medical Center, Nijmegen, Netherlands
c Department of Interventional Radiology, Royal Marsden Hospital NHS Foundation Trust, London, UK
d Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK
e Department of Radiology, Interventional Oncology-Stereotaxy and Robotics, Medical University Innsbruck, Tirol-Kliniken, Innsbruck, Austria
f Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
g Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
h Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
i Department of Radiology, University Hospital Regensburg & Klinikum Ernst von Bergmann, Potsdam, Germany
j Department of Radiology, University Hospital Southampton, Southampton, UK
k Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
l Department of Surgical Sciences, University of Torino, Turin, Italy
m Department of Diagnostic and Interventional Radiology, Città della Salute e della Scienza, Turin, Italy
n Department of Radiology, Show-Chwan Memorial Hospital, Changhua, Taiwan
o Department of Division of Interventional Radiology, University of Pisa-Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
p Department of Hepato-Pancreato-Biliary Surgery and Surgical Oncology, Maastricht University Medical Center & GROW Research Institute for Oncology and Reproduction, Maastricht, Netherlands
q Centre Hospitalier Universitaire de Liege, Liege, Belgium
r Universitätsklinikum Essen, Essen, Germany
s Department of Radiology and Interventional Radiology, Lausanne University Hospital CHUV, Lausanne, Switzerland
t The Intervention Centre, and Department of HPB Surgery, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
u 2nd Department of Radiology, University General Hospital “ATTIKON” Medical School, National and Kapodistrian University of Athens, Athens, Greece
v Department of Surgery, City of Hope National Medical Center, Duarte, CA, USA
w Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
x Department of IGS and Percutaneous Surgery, IRCAD University, Strasbourg, France
y Department of Interventional Medicine, Einstein Hospital Israelita, São Paulo, Brazil
z Department of Diagnostic & Interventional Radiology, Università Campus Bio-Medico, Policlinico Universitario Campus Bio-Medico, Rome, Italy
aa Department of Diagnostic and Interventional Radiology and Nuclear Medicine, München Klinik Bogenhausen, Munich, Germany
ab Advanced Interventional Radiology Unit, Department of Diagnostic Imaging and Oncologic Radiotherapy, Fondazione Policlinico Universitario “Agostino Gemelli”-IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
ac Division of Interventional Radiology, Department of Radiology, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria
ad Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
ae Department of Radiology, Biomedical Engineering, and Urology, University of Wisconsin-Madison, Madison, WI, USA
af Department of Radiology, Seoul National University Hospital, Seoul, South Korea
ag Department of Radiology and Nuclear Medicine, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
ah Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, Netherlands
ai GROW School for Oncology and Reproduction, Maastricht University, Maastricht, Netherlands
aj Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China
ak Department of Surgery, Show-Chwan Memorial Hospital, Changhua, Taiwan
al Department of Radiology, University Hospital Regensburg, Germany
am Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Austria
an Department of Diagnostic and Interventional Radiology and Nuclear Medicine, St Josef-Hospital, University Hospital, Ruhr University Bochum, Bochum, Germany
ao Department of Radiology, David Geffen School of Medicine UCLA Health System, Los Angeles, CA, USA
ap Department of Radiology, Hospital das Clínicas, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
aq Department of Interventional Radiology, Miami Cancer Institute, Miami Cardiac & Vascular Institute, Baptist Health South Florida, Miami, FL, USA
ar Department of Interventional Radiology, IRCCS European Institute of Oncology, Milan, Italy
as Department of Radiology, Minimally Invasive Therapies & Nuclear Medicine, SLK-Clinics Heilbronn, Ruprecht-Karls-University Heidelberg, Heilbronn, Germany
at Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore
au Department of Radiology, Samsung Medical Center, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
av Department of Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
aw Department of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, Netherlands
ax Division of Interventional Radiology, Department of Radiology, University Hospital Waterford, Waterford City, Ireland
ay Royal College of Surgeons in Ireland, Dublin, Ireland
az University College Cork, Cork, Ireland
ba Department of Abdominal Imaging & Intervention, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
bb Department of Hepato-Pancreato-Biliary Surgery, Manchester Royal Infirmary, Manchester, UK
bc Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Utrecht, Netherlands
bd Weil-Cornell Medical College Interventional Oncology/Radiology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
be Department of Radiology, IRCCS Humanitas Clinical and Research Hospital & Humanitas University, Rozzano, Milan, Italy
bf Department of General, Visceral & Vascular Surgery, Kepler University Hospital, Linz, Austria
bg Clinical Research Institute for Inflammation Medicine, Medical Faculty, Johannes Kepler University, Linz, Austria
bh Department of Radiology, St Antonius Hospital, Nieuwegein, Netherlands
bi Department of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
bj Department of Visceral Surgery and Transplantation, University Hospital Zürich, University of Zurich, Zürich, Switzerland
bk Department of Interventional Radiology, Gustave Roussy Cancer Center, Villejuif, France
bl Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
bm Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
bn Department of Diagnostic & Interventional Radiology, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
bo Department of Radiology and Nuclear Medicine, Städtisches Klinikum Braunschweig, Braunschweig, Germany
bp Department of Radiology and Imaging Science, National Institutes of Health Clinical Center, Bethesda, MD, USA
bq Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
br Department of Radiology, Image-guided Therapy and Interventional Oncology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel
* Correspondence to: Prof Reto Bale, Department of Radiology, Interventional Oncology-Stereotaxy and Robotics, Medical University Innsbruck, Tirol-Kliniken, Innsbruck 6020, Austria Department of Radiology Interventional Oncology-Stereotaxy and Robotics Medical University Innsbruck Tirol-Kliniken Innsbruck 6020 Austria
Summary |
This multisociety, multidisciplinary consensus—formally endorsed by the European Society of Surgical Oncology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology—was developed to standardise the assessment of ablation margins in liver tumour thermal ablation. A modified Delphi process, consisting of two online surveys and a hybrid (online and in-person meeting in Innsbruk) consensus meeting of 72 experts from North America, South America, Europe, and Asia. Formal consensus was reached for 150 (75%) of 199 statements. Strong agreement was observed between interventional and surgical oncologists, with only 12 (6%) of 199 statements showing significantly different ratings. Participants agreed that ablation margins should be assessed and documented for every treated tumour. Margins should be assessed quantitatively in three dimensions, with contrast-enhanced CT or MRI, preferably intraprocedurally with ablation confirmation software. Ablation margins should be categorised as A0 (tumour completely covered with sufficient margin), A1 (tumour completely covered but insufficient margin), or A2 (portion of tumour remains unablated). This effort is, to our knowledge, the first international consensus initiative to define best-practice recommendations for margin assessment in liver tumour thermal ablation to standardise practices, aiming to improve and promote uniform outcomes.
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Vol 27 - N° 5
P. e248-e258 - mai 2026 Retour au numéro
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