Echogenicity of Liver Metastases Is an Independent Prognostic Factor After Potentially Curative Treatment

Abstract

Hypothesis: Intraoperative echogenic appearance of liver metastases from colorectal cancer is a prognostic factor of outcome after curative treatment. Design: Retrospective analysis of prospectively collected data. Setting: Department of Surgery at a university hospital. Patients: One hundred forty-three consecutive patients with hepatic metastases from colorectal cancer who underwent liver resection with curative intent between 1992 and 1998. Intervention: Curative treatment was achieved by liver resection alone, liver resection plus edge cryotherapy, or liver resection plus cryotherapy to lesions not amenable to further resection. In patients with more than 2 lesions, a hepatic artery catheter was placed for regional chemotherapy. Main Outcome Measures: The echogenic appearance of the liver metastases was assessed by intraopera-tive ultrasound by a single person throughout the study using a 5-MHz ultrasound probe. The findings were prospectively entered into the database. Results: Fifty-four percent of patients had hyperechoic metastases. This group had significantly longer overall (log rank, PϽ.001) and recurrence-free survival (log rank, P=.004) compared with patients who had hypoechoic metastases (36%). A significantly higher percentage of mucinsecreting tumors were found in the hypoechoic patient group (2 , P =.001). Dukes stage of the primary tumor (P =.02), echogenicity of the liver secondaries (P=.04), and diameter of the largest resected metastasis (P=.01) were independent prognostic factors for recurrencefree survival in the Cox regression model. Conclusion: These results support the hypothesis that echogenicity of liver metastases from colorectal cancer is an independent prognostic factor of outcome after curative resection.

Patient Variability in Intraoperative Ultrasonographic Characteristics of Colorectal Liver Metastases

“…Currently, there are few data on the IOUS characteristics of colorectal liver metastases. The few previous studies [13][14][15] that have examined the echogenicity of colorectal liver metastasis reported that the majority (54%-65%) of colorectal liver metastases were hyperechoic in nature. In contrast, in the current study, most colorectal liver metastases were found to be hypoechoic (52.0%).…”

“…Colorectal metastases can appear hypoechoic, isoechoic, or hyperechoic in comparison with the surrounding liver tissue. [13][14][15] The echogenicity of the metastasis can influence the surgeon's ability to detect lesions on IOUS because isoechoic…”

Echogenic Appearance of Colorectal Liver Metastases on Intraoperative Ultrasonography is Associated with Survival After Hepatic Resection

“…Other investigators have suggested that hypoechoic lesions were significantly more likely to be mucinproducing tumors. 10 Mucin secretion is an established negative prognostic factor for primary colorectal cancer. 26,27 In the current study, we similarly noted that hypoechoic lesions were more likely to be mucin-producing, although this did not reach statistical significance.…”

Intraoperative Ultrasound of the Liver: Actual Status and Indications

“…Several studies in the literature have shown that after the surgical treatment of the primary tumor, the ultrasound of metastasis after colorectal cancer can be correlated with prognosis. Thus, Gruenberger et al [52] demonstrated that in patients with hyperechoic ultrasound liver metastases, survival is longer than in those with the hypoechoic aspect of the lesions. This suggests that the role of IOUS is more than a diagnostic one and can be useful in establishing prognosis [53].…”