Intraoperative sonography of hepatocellular carcinoma: Detection of lesions and validity in surgical resection

Choi, Byung Ihn; Han, Joon Koo; Song, In Sup; Kim, Chu Wan; Han, Man Chung; Kim, Soo Tae; Lee, Hyo Suk; Kim, Chung Yong; Kim, Yong Il

doi:10.1007/bf01887381

Cited by 20 publications

(6 citation statements)

References 14 publications

(16 reference statements)

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“…The sensitivity for detecting HCCs less than 3 cm in diameter is widely variable, ranging from 46-84% for conventional CT, 61-81% for angiography, 86-91% for CT arterial portography (CTAP), and 71-96% for iodized oil CT [2,3,23,24]. The diagnostic modality with the highest success rate reported is intraoperative US, with sensitivity ranging from 94 to 96% [2,24].…”

Section: Hepatocellular Carcinomamentioning

confidence: 99%

See 1 more Smart Citation

The role of contrast-enhanced ultrasound in the detection of focal liver leasions

et al. 2001

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IntroductionOver the last decade, the therapeutic approach for treating focal liver malignancies, including both hepatocellular carcinoma (HCC) and metastatic lesions, has changed dramatically, particularly due to the proliferation of new treatment strategies. These have included percutaneous ablative therapies such as percutaneous ethanol injection (PEI), thermal therapies such as radiofrequency (RF), laser, and microwaves, as well as angiographic therapies such as segmental chemoembolization and hypoxic perfusion, and orthotopic liver transplantation (OLT). Furthermore, at the same time, there has been a general greater acceptance of previously characterized, more standard treatment modalities such as surgical resection and systemic chemotherapy. Given this wide range of potential therapeutic options, a main aim of current medical management of focal liver cancer is to tailor therapy for every patient by selecting the therapeutic modality which will ideally provide the highest success rate, fewest risks and lowest costs for each given situation. However, in order to provide this level of optimized, individualized care, accurate detection of neoplastic lesions by imaging modalities including ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MRI) is mandatory.Worldwide, US is the most widely available imaging modality for the screening of liver pathology, and has furthermore functioned as the mainstay for screening efforts for the detection of small incidental hepatomas in high-risk patients. Nevertheless, the limitations of conventional gray-scale B-mode US for the detection of focal liver lesions have been well documented [1,2]. Color Doppler and power Doppler increased the sensitivity for hepatic lesion detection compared to grayscale US, but they did not allow levels of sensitivity comparable to those of contrast enhanced axial imaging (CT and MRI). Two breakthroughs in US, harmonic imaging and the development of second-generation contrast agents, have recently been described and have demonstrated the potential to dramatically broaden the scope of US diagnosis of hepatic lesions. This paper will review the prior state of the art for the sonographic detection of the two most common forms of focal liver neoplasia (HCC and metastases), and illustrate the potential of the newer techniques for improving the sensitivity of US . Historical review of conventional ultrasonography Hepatocellular carcinomasThe detection rate of HCC using US is related to the size, location, and echotexture of the lesions, as well as to both the US technology employed and operator experience. Nevertheless, due to successive technologic improvements, there has been a trend toward detecting ever smaller lesions. Given a wide range of techniques and technology, the reported detection rate of HCCs measuring less than 2 cm in diameter has been variable, ranging from 46% to 95% [1, 3, 4], with accurate detection of 82-93% of HCCs measuring between 2 and 3 cm. For HCCs smaller than 1 cm, US is reported to have a detecti...

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Section: Hepatocellular Carcinomamentioning

confidence: 99%

“…The diagnostic modality with the highest success rate reported is intraoperative US, with sensitivity ranging from 94 to 96% [2,24]. In most comparative analyses, the sensitivities of intraoperative US, CTAP, and iodized oil CT are higher than those of US, CT, and angiography [3,23,24].…”

Section: Hepatocellular Carcinomamentioning

confidence: 99%

The role of contrast-enhanced ultrasound in the detection of focal liver leasions

et al. 2001

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“…However, intraoperative sonography remains crucial in patients with hepatocellular carcinoma, as its allows safer resection [34] and allows detection of small nonpalpable nodules. Choi et al [35] found an overall sensitivity of 98 % for intraoperative sonography in the detection of hepatocellular carcinoma in a series involving 67 patients with a total of 86 nodules of hepatocellular carcinoma; all nodules being undetected by intraoperative sonography were smaller than 2 cm. In their series, Choi et al [35] found that the superiority of intraoperative sonography over surgical inspection and palpation was more manifest for small nodules.…”

Section: Conventional Intraoperative Sonographymentioning

confidence: 98%

“…Choi et al [35] found an overall sensitivity of 98 % for intraoperative sonography in the detection of hepatocellular carcinoma in a series involving 67 patients with a total of 86 nodules of hepatocellular carcinoma; all nodules being undetected by intraoperative sonography were smaller than 2 cm. In their series, Choi et al [35] found that the superiority of intraoperative sonography over surgical inspection and palpation was more manifest for small nodules. Among the 35 nodules which were smaller than 2 cm, 22 (63 %) were either not seen or nonpalpable during surgey, whereas four (11 %) nodules only were missed by intraoperative sonography.…”

Section: Conventional Intraoperative Sonographymentioning

confidence: 98%

Intraoperative and laparoscopic sonography of the liver

Mosnier

Choti

Rymer³

1997

Eur Radiol

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Intraoperative sonography is an important aid in the decision making process during open surgery because it can detect additional small liver tumours that may not be depicted preoperatively, even with the use of modern non invasive imaging modalities. A continued important role of intraoperative sonography is to determine hepatic anatomy, allowing for safer and easier hepatic surgery with increased parenchymal preservation. Intraoperative sonography is also used for monitoring cryogenic ablation of hepatic tumour. To overcome the inherent limitations of laparoscopic surgery, laparoscopic sonography can now be used to provide information not available during laparoscopy or laparoscopic surgery alone. In this article, the authors present the most recent techniques for intraoperative sonography. Also they emphasize the important role of intraoperative sonography and laparoscopic sonography in the surgical decision-making process in patients with hepatic or biliary disease and report the most recent advances in intraoperative sonography with respect to the treatment of hepatic tumours. Finally, they try to look forward at the possible use for intraoperative technologies that are now in their early stages.

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“…19 (1998) Tab. 1 llteraturuberslcht: Sensitlvitat von praoperativer Sonographie und CT im Vergleich zur intraoperativen Sonographie beziiq lich des Nachweises von Raumforderungen in der Leber [10,11,13,16,18 Tab. 4 Anzahl der Tumorlokalisationen in den Lebersegmenten -Vergleich Sonographie und CT mit intraoperativem Ultraschall.…”

Section: Schlusselworter: Lebertumoren -Operationsplanung -Farbdoppleunclassified

Farbdopplersonographie in der Leberchirurgie

Bunk¹,

Stoelben²,

Konopke³

et al. 2008

Ultraschall in Med

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Using high-resolution ultrasound systems the preoperative detection of lesions in the liver achieves the results of CT-scan. Little isoechogenic lesions, peritoneal spread and locoregional recurrences can be missed by ultrasound examination. Colour Doppler imaging shows compared with B-mode and CT-scan a higher sensitivity for the detection of the infiltration of hilar structures and can take place of more invasive methods in preoperative liver investigations. Considering functional and morphological aspects colour Doppler imaging makes an essential contribution to the planning of liver surgery. Using lung passing contrast media the determination of tumour vascularisation and perioperative quantification of liver perfusion is possible. The use of the intraoperative ultrasound is justified to determine resection limits, detection of smallest non-palpable lesions and to control perfusion after vascular reconstruction. In experienced hands colour Doppler imaging gives valuable preoperative information with excellent cost-benefit ratio.

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Intraoperative sonography of hepatocellular carcinoma: Detection of lesions and validity in surgical resection

Cited by 20 publications

References 14 publications

The role of contrast-enhanced ultrasound in the detection of focal liver leasions

The role of contrast-enhanced ultrasound in the detection of focal liver leasions

Intraoperative and laparoscopic sonography of the liver

Farbdopplersonographie in der Leberchirurgie

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