The role of intraoperative ultrasound for the assessment of the focal liver lesions in patients with colorectal cancer

Abstract

Objective: To evaluate the concordance between intraoperative ultrasound (IOUS) and abdominal ultrasound (US) for the characterization of focal liver lesions in patients with colorectal cancer, and to evaluate the way in which IOUS influences the initially established hepatic surgical protocol based on abdominal US only. Method: In this prospective study 73 patients with colorectal cancer and focal liver lesions found during IOUS were included. Abdominal US and IOUS findings were compared. The initially established hepatic surgical protocol based on abdominal US only was recorded. All patients in whom IOUS influenced this protocol and the way in which this was influenced were recorded. Results: Of the 73 patients, 41 (56.2%) had focal liver lesions classified as malignant by IOUS. In 26 of the 73 patients (35.6%), there were discordances between abdominal US and IOUS. IOUS influenced the operative protocol in 9 of the 73 patients included in the study (12.3%), and in 8 of the 41 patients with malignant lesions (19.5%). IOUS influenced the operative protocol by cancelling the preoperative hepatic surgery decision by evidencing the additional multiple malignant focal liver lesions, following the classification of some lesions as benign or by demonstrating the non-resectable character of other lesions. IOUS also determined unplanned hepatic resections by detecting resectable malignant lesions undiagnosed by abdominal US, and extended or limited the scheduled hepatic surgery based on abdominal US only. Conclusions: There were inconsistencies between IOUS and abdominal US, therefore in patients with colorectal cancer IOUS provided additional information about focal liver lesions. IOUS influenced the operative protocol and consequently, unnecessary liver surgery was avoided. Also, IOUS identified malignant resectable liver lesions which were undetected by abdominal US.

Imaging of Liver Tumors Using Surface-Enhanced Raman Scattering Nanoparticles

“…4–6 Ultrasound is the modality that is currently used most frequently for metastatic survey of the liver in the operating room. 7–8 However, ultrasound has limited sensitivity and signal specificity, resulting in the difficulty of distinguishing cancer from normal tissue and inability to visualize microscopic disease. 8, 9 Therefore, there is a large unmet need for new imaging technologies that allow accurate intraoperative assessment of liver neoplasms.…”

“…The use of intraoperative MRI in the abdomen would be especially difficult because breathing motion can compromise image quality. PET suffers from other limitations, such as the high uptake of 18 F-fluorodeoxyglucose ( 18 F-FDG) in normal liver tissue, its limited spatial resolution, and the drawback of exposure to ionizing radiation. − Ultrasound is the modality that is currently used most frequently for metastatic survey of the liver in the operating room. , However, ultrasound has limited sensitivity and signal specificity, resulting in the difficulty of distinguishing cancer from normal tissue and the inability to visualize microscopic disease. , Therefore, there is a large unmet need for new imaging technologies that allow accurate intraoperative assessment of liver neoplasms. ,, …”

Intraoperative ultrasound for the colorectal surgeon: current trends and barriers

“…Hypovascular malignant lesions appear as hypoenhancing nodular lesions or lesions with a peripheral halo or ‘rim enhancement’. Hypervascular lesions appear hyperenhancing throughout the arterial phase . In the parenchymal phase, most malignant lesions are hypoenhancing whereas most solid benign lesions are iso‐ or hyperenhancing…”

<p>Dual-Mode Contrast Agents with RGD-Modified Polymer for Tumour-Targeted US/NIRF Imaging</p>

“…[8][9][10] In contrast to expensive and time-consuming CT, MRI or PET clinical examinations, patients can be administered microbubbles at the bedside, and the microbubbles allow the precise localization of lesions within a few minutes of administration to guide biopsies, ablation or rapid diagnosis. [11][12][13] However, the low sensitivity of ultrasound molecular imaging limits the early detection of lesions, which is closely related to the survival rate of cancer patients. [14][15][16] The features of near-infrared fluorescence (NIRF), including its deep tissue penetration, low background fluorescence interference and low biotoxicity, can overcome the limitations of ultrasound.…”