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

Abstract

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.

Resection for Colorectal Liver Metastases

“…In patients treated with neoadjuvant chemotherapy, magnetic resonance imaging measurements of steatosis show the highest correlation coefficient and the best diagnostic accuracy, as compared to computed tomography ones (Marsman et al, 2011). Intraoperative ultrasound and preoperative imaging significantly increase the diagnostic accuracy of patients undergoing liver resection for colorectal liver metastases (Lordan et al, 2011). Metachronous resections have a better outcome than synchronous.…”

Current Status of Imaging to Evaluate Liver Metastases From Colorectal Cancer

“…In the 1980s, the technique of intraoperative ultrasound (IOUS) was established and since that time has been further refined [17][18][19]. The literature includes studies with a wide range of sensitivities of IOUS (61-92 %) [18,[20][21][22].…”

“…In the 1980s, the technique of intraoperative ultrasound (IOUS) was established and since that time has been further refined [17][18][19]. The literature includes studies with a wide range of sensitivities of IOUS (61-92 %) [18,[20][21][22]. Despite this variability, most studies have suggested that the addition of IOUS to preoperative cross-sectional imaging can allow for identification of additional foci of CRLM, and therefore, including this tool in surgical planning has been recommended [18,20,23].…”

“…Figure 1 illustrates multiple CRLM detected by IOUS. Lordan et al found that when comparing imaging to actual histologic findings, cross-sectional imaging alone had an accuracy of 69 % (sensitivity 82 %, specificity 86 %), and IOUS alone had an accuracy of 61 % (sensitivity 84 %, specificity 77 %); however, when these diagnostic modalities were used in combination, the accuracy increased to 78 % (p= 0.001; sensitivity 88 %, specificity 84 %) [18].…”

Ultrasound Examination in Detection and Characterization of Colorectal Liver Metastases

“…In contrast, intraoperative ultrasonography (IOUS) provides high-resolution imaging and is frequently used for intraoperative decision making. The reported sensitivity of IOUS ranged from 85% to 95% [26][27] . However, the performance of US and IOUS are dependent on the operator's experience, lesion size, location, and echogenicity of the lesions.…”