Can liver surgeons really rely on today’s imaging for CRLM?

Abstract

Background: Modern imaging techniques are supposed to have best detection rates if properly performed and combined. Our study aimed at comparing the results of optimal preoperative imaging to state of the art intraoperative ultrasound with contrast media. Methods: 47 patients received CEUS, 3-phasic MDCT, 3 Tesla MRI with PrimovistÒ and intraop Palpation/IOUS/ CEIOUS. Histology was gold standard. All lesions were recorded and printed on liver schemes to be comparable between modalities. Diagnostic accuracy was defined as the statistical parameter to resemble a surgeons point of view. Uni-and multivariate as well as ROC analysis of lesion size was conducted to find the lesion size threshold at which accuracy decreased. Results: 47 patients with CRLM (M:F 33:14/ Colon:Rectum 29:18) were analyzed. 30% had been submitted to modern preoperative chemotherapy. Histopathology confirmed 264 lesions (245m:19b). Accuracy for detection:CEUS 63% (k 9%), CT/MRI 82% (k 27%) and PALP/IOUS/CEIOUS 99%(k 88). ROC analysis showed severe impairment of accuracy in lesion detection at 5mm size for preop Imaging. Co-Factors being significant on univariate analysis were excluded in multivariate analysis (MVA). MVA confirmed that preop imaging was much better in detection of lesions >5mm e accuracy of intraop imaging was not impaired. Conclusion: At 5mm lesion size all preoperative imaging loose accuracy of detection. Therefore CT scans are appropriate to develop a strategy. The only imaging that keeps accuracy is intraoperative imaging.