Background: Hepatocellular carcinoma (HCC) is the commonest primary cancer of the liver. Incidence is increasing and HCC has risen to become the 5th commonest malignancy worldwide and the third leading cause of cancer related death. According to the BCLC staging system image-guided tumor ablation is recommended in patients with early stage HCC. Microwave ablation (MWA), is a thermal ablative technique that has recently emerged as a new therapeutic option. The aim of this study was to evaluate the use of microwave ablation in hepatocellular carcinoma treatment and to assess the outcome.
 Methods: This study was carried out on 52 patients proved to have HCC who presented to Radiology Department in Alexandria University Hospitals. Microwave ablation was performed percutaneously under real-time ultrasound guidance using a GE LOGIQ 5 Pro US scanner (USA) with a 3.5–5 MHz probe, to completely destroy the tumor, as well as the surrounding 0.5–1.0 cm normal appearing liver tissue (safety margins). The patients were observed two hours before discharge. Contrast-enhanced triphasic CT imaging needed to be performed at 1 month after the ablation.
 Results: All patients completed the procedure safely.  The outcome, as determined by dynamic CT performed 1 month after percutaneous MWA, was achieved in 66 (97%) of 68 lesions. The technical success rates for tumors smaller than 3 cm and those 3-5 cm were 97.2% (35 of 36 nodules) and 96.9% (31 of 32 nodules), respectively
 Conclusion: Thermal ablation, including radiofrequency ablation (RFA) and microwave ablation (MWA), have been shown to be effective for treating HCC. Microwave ablation is a safe, effective and

 
promising technique and a good replacement to surgical interference for patients who are not amenable to surgical therapy.