Intra‐operative ultrasound for detection of liver metastases from colorectal cancer

Mazzoni, Gianluca; Napoli, Alessandro; Mandetta, S; Miccini, Michelangelo; Cassini, Diletta; Gregori, Matteo; Colace, Lidia; Tocchi, A

doi:10.1111/j.1478-3231.2007.01583.x

Cited by 30 publications

(33 citation statements)

References 39 publications

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“…3,[9][10][11][12] However, some earlier studies reported a limited clinical value of IoUS. 13,14 Regarding detection of liver lesions, PoI alone attains a sensitivity of 41-68% with transabdominal ultrasound, 60-75% with contrastenhanced CT and 80-85% with MRI.…”

Section: Discussionmentioning

confidence: 99%

The value of intraoperative ultrasound and preoperative imaging, individually and in combination, in liver resection for metastatic colorectal cancer

Lordan

Stenson

Karanjia

2011

annals

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INTRODUCTION Liver resection is proved to offer potential long-term survival for colorectal liver metastases (CRLM). Accurate radiological assessment is vital to enable an appropriate surgical approach. The role of intraoperative ultrasound (IOUS) has been controversial. This study was designed to analyse the accuracy of IOUS compared with that of preoperative imaging (POI) in these patients. MATERIALS AND METHODS A prospective analysis of 51 consecutive patients who underwent liver resection for CRLM was undertaken. The accuracy of POI and IOUS were correlated and compared with histopathological analysis. Statistical analyses included t-tests, to compare continuous variables, and chi-square and Fisher's exact tests to compare categorical variables. p<0.05 was considered significant RESULTS POI correlated with histology in 35 patients (68.6%). The sensitivity and specificity were 82.4% and 86.3% respectively. IOUS correlated with histology in 31 (60.8%) patients. The sensitivity and specificity were 84.3% and 76.5% respectively. There was no difference in accuracy between modalities. The accuracy of POI combined with IOUS correlated with histology in 40 patients (78.4%). The sensitivity and specificity were 88.2% and 84.3% respectively. The accuracy of combined modalities was significantly greater than IOUS or POI alone. CONCLUSIONS POI combined with IOUS may significantly increase the diagnostic accuracy of patients undergoing liver resection for CRLM.

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Section: Discussionmentioning

confidence: 99%

The value of intraoperative ultrasound and preoperative imaging, individually and in combination, in liver resection for metastatic colorectal cancer

Lordan

Stenson

Karanjia

2011

annals

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“…It has been shown that conventional ultrasonography is particularly useful when applied intra-operatively for imaging liver metastases and has been utilised with great success for many years [30][31][32][33]. Propagation of ultrasonic waves is not hindered to any significant degree during liver metastasis surgery because laparotomy is performed prior to data capture.…”

Section: Discussionmentioning

confidence: 99%

Visualisation of liver tumours using hand-held real-time strain imaging: results of animal experiments

Melodelima

Chenot²,

Souchon³

et al. 2012

BJR

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Objective: Surgical resection is the only curative option for colorectal hepatic metastases. Intra-operative localisation of these metastases during hepatic resection is performed by intra-operative B-mode imaging and palpation. Because liver metastases are stiffer than normal tissues, elastography may be a useful complement to B-mode imaging. This paper reports quantitative measures of the image quality attained during intra-operative real-time elastographic visualisation of liver metastasis. Methods: VX2 tumours were implanted in the liver of eight rabbits and were scanned in vivo. Measurements of the tumour dimensions obtained via elastography were compared with those obtained using B-mode imaging and with gross pathology. Results: Measurements of tumour diameters were similar when obtained by intraoperative elastography and pathological measurement methods (mean difference ¡ standard deviation, 0.1¡0.9 mm). The contrast between tumours and normal tissues was significantly higher (p,0.05) in elastograms (26¡10 dB contrast) than in sonograms (1¡1 dB contrast). Sensitivity and specificity for detecting tumours using intra-operative elastography were 100% and 88%, respectively, and positive and negative predictive values were 89% and 100%, respectively. In two cases elastograms were able to detect a tumour that was ambiguous in B-mode images. Conclusion: Combined hand-held B-mode/strain imaging may provide additional information that is relevant for detection of liver metastases that may be missed by standard B-mode imaging alone, such as small and/or isoechoic tumours. Colorectal cancer is the fourth most common cancer in males and the third most common cancer in females worldwide [1,2]. Approximately half of these patients either present with hepatic metastases or develop them during the course of their disease. Although ablative therapies are frequently used, resection of liver metastases, when possible, remains the preferred therapy for potential cure [3,4]. The overall 5 year survival rates are in the range of 35-58% in several studies reporting on the results of hepatectomy conducted with curative intent [4,5]. The pre-operative and intra-operative staging of metastases is essential to remove all metastases and increase the rate of cure. At the pre-operative stage, contrast-enhanced CT is the most commonly used modality to screen for metastases. It is highly sensitive, particularly since the introduction of helical CT and multidetector systems capable of scanning the entire liver in a few seconds, allowing for several scans during the liver's different circulatory phases [6]. MRI is very sensitive as well, and has the advantage of liver-specific contrast if required. MRI is also used for screening purposes, despite the fact that it is more time-consuming than other methodologies and may be subject to motion artefacts [7]. According to different reports, these modalities detect .90% of liver metastases if their diameter is .5 mm [7,8]. There is still a group of patients who undergo hepatic surgery without c...

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“…Une étude récente montrait que seuls trois patients sur 271 (1 %) opérés d'un CCR présentaient des MHS découvertes en peropéra-toires alors même que la TDM multibarrette préopératoire était normal [57]. Cependant, la découverte peropératoire de MHS peut entraîner une modification de la stratégie chirurgicale [58].…”

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Prise en charge des patients atteints de métastases hépatiques synchrones du cancer colorectal. Recommandations pour la Pratique Clinique. Recommandations de la Société française de chirurgie digestive (SFCD) et de l’association de chirurgie hepatobiliaire et de transplantation hépatique (ACHBT). Texte court

Zalinski

Mariette

Farges

2011

Journal de Chirurgie Viscérale

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Intra‐operative ultrasound for detection of liver metastases from colorectal cancer

Abstract: IOUS is safe, simple to perform and more accurate than pre-operative imaging. It reduces the number of patients subjected to superfluous surgery. The use of IOUS is therefore encouraged during colorectal cancer surgery.

Cited by 30 publications

References 39 publications

The value of intraoperative ultrasound and preoperative imaging, individually and in combination, in liver resection for metastatic colorectal cancer

The value of intraoperative ultrasound and preoperative imaging, individually and in combination, in liver resection for metastatic colorectal cancer

Visualisation of liver tumours using hand-held real-time strain imaging: results of animal experiments

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