Accuracy of computerized tomography in determining hepatic tumor size in patients receiving liver transplantation or resection.

Abstract

Computerized tomography (CT) of liver is used in oncologic practice for staging tumors, evaluating response to treatment, and screening patients for hepatic resection. Because of the impact of CT liver scan on major treatment decisions, it is important to assess its accuracy. Patients undergoing liver transplantation or resection provide a unique opportunity to test the accuracy of hepatic-imaging techniques by comparison of findings of preoperative CT scan with those at gross pathologic examination of resected specimens. Forty-one patients who had partial hepatic resection (34 patients) or liver transplantation (eight patients) for malignant (30 patients) or benign (11 patients) tumors were evaluable. Eight (47%) of 17 patients with primary malignant liver tumors, four (31%) of 13 patients with metastatic liver tumors, and two (20%) of 10 patients with benign liver tumors had tumor nodules in resected specimens that were not apparent on preoperative CT studies. These nodules varied in size from 0.1 to 1.6 cm. While 11 of 14 of these nodules were less than 1.0 cm, three of 14 were greater than 1.0 cm. These results suggest that conventional CT alone may be insufficient to accurately determine the presence or absence of liver metastases, extent of liver involvement, or response of hepatic metastases to treatment.

A High Circulating Tumor Cell Count in Portal Vein Predicts Liver Metastasis From Periampullary or Pancreatic Cancer

“…Positron emission tomography (PET) is also unable to detect micrometastatic disease because of limited resolution of 4 to 10 mm. 1 , 2 Operation on patients with image-indiscernible micrometastasis will subject them to operative risk and delay in systemic therapy without any benefit in survival. One method of screening out micrometastatic disease can avoid an unnecessary or even harmful operation.…”

Liver transplantation in the adult

“…Despite the variety of methods now available for the detection of extrahepatic spread prior to transplantation, including thoracic and abdominal computed tomographic (CT) scan, abdominal lymphangiography, and radioisotope bone scan, small tumor deposits may still not be detected. Indeed, in the study of Mittal et al [2] in which the accuracy of preoperative CT scan was compared with gross pathological examination of the resected specimen, between 20 and 47% of the various patient groups had tumor nodules evident macroscopically that were not apparent on the scan. For this reason in our program a final search by mini-laparotomy is now carried out routinely before the decision is taken to go ahead with a liver graft.…”

Scalable Multilayer Cell Collector to Capture Circulating Tumor Cells with an Unlimited Volume Capacity

“…The survival rate significantly drops when cancer metastasis occurs. , Monitoring the progression of cancer and preventing its metastasis has therefore become one major clinical goal. For this purpose, imaging-based methods such as contrast-enhanced computed tomography, magnetic resonance imaging, positron emission tomography, and biochemistry-based assays have been developed and used clinically for the detection and monitoring of cancer stages. , These methods, however, are designed to detect tumors that have already metastasized and colonized and hence cannot be used for the direct prevention or control of cancer metastasis.…”