Imaging-based prediction of hepatocellular carcinoma recurrence after microwave ablation as bridge therapy: A glimpse into the future

Liver transplantation (LT) remains the treatment of choice for early-stage hepatocellular carcinoma (HCC) and offers the best long-term oncological outcomes. However, the increasing waiting list for LT has led to a significant dropout rate as patients experience tumor progression beyond the Milan criteria. Currently, locoregional therapies, such as microwave ablation (MWA), have emerged as promising bridge treatments for patients awaiting LT. These therapies have shown promising results in preventing tumor progression, thus reducing the dropout rate of LT candidates. Despite the efficacy of MWA in treating HCC, tumoral recurrence after ablation remains a major challenge and significantly impacts the prognosis of HCC patients. Therefore, accurately diagnosing tumoral recurrence post-ablation is crucial. Recent studies have developed novel imaging features based on magnetic resonance imaging of HCC, which could provide essential information for predicting early tumoral recurrence after MWA. These advancements could address this unresolved challenge, improving the clinical outcomes of patients on the LT waiting list. This article explored the current landscape of MWA as a bridge therapy for HCC within the Milan criteria, highlighting the emerging role of novel imaging-based features aimed at improving the prediction of tumor recurrence after MWA.