Therapeutic response assessment using 3D ultrasound for hepatic metastasis from colorectal cancer: Application of a personalized, 3D-printed tumor model using CT images

Abstract

Background & aimsTo evaluate accuracy and reliability of three-dimensional ultrasound (3D US) for response evaluation of hepatic metastasis from colorectal cancer (CRC) using a personalized 3D-printed tumor model.MethodsTwenty patients with liver metastasis from CRC who underwent baseline and after chemotherapy CT, were retrospectively included. Personalized 3D-printed tumor models using CT were fabricated. Two radiologists measured volume of each 3D printing model using 3D US. With CT as a reference, we compared difference between CT and US tumor volume. The response evaluation was based on Response Evaluation Criteria in Solid Tumors (RECIST) criteria.Results3D US tumor volume showed no significant difference from CT volume (7.18 ± 5.44 mL, 8.31 ± 6.32 mL vs 7.42 ± 5.76 mL in CT, p>0.05). 3D US provided a high correlation coefficient with CT (r = 0.953, r = 0.97) as well as a high inter-observer intraclass correlation (0.978; 0.958–0.988). Regarding response, 3D US was in agreement with CT in 17 and 18 out of 20 patients for observer 1 and 2 with excellent agreement (κ = 0.961).Conclusions3D US tumor volume using a personalized 3D-printed model is an accurate and reliable method for the response evaluation in comparison with CT tumor volume.

Systematic review of the applications of three‐dimensional printing in colorectal surgery

“…Finally, Choi et al [16] demonstrated high correlation and strong concordance between 3D US and CT scanning in the evaluation of the response of colorectal liver metastases to chemotherapy. 3D volume evaluation of tumour size is superior to unidimensional and bidimensional measurement as it overcomes the difficulty of determining the diameter of irregular or conglomerated lesions [23].…”

“…Nine studies [8][9][10][11][12][13][14][15][16] were found to be eligible for the present review, all of which were included. The studies were published between 2014 and 2018.…”

“…The uses of 3D printing across the eight studies included are illustrated in Table 2 and can be classified into the following three categories: (1) patient education [8], (2) preoperative planning [9][10][11][12][13][14][15] and (3) evaluation of response of colorectal liver metastasis to chemotherapy [16].…”

“…The utility of 3D printed stoma models also helped medical staff members to better examine and resolve the problems associated with stomas, as in one patient who developed caving of the stoma and soiling and erosion of the surrounding skin that was resolved after discussion with the patient and provision of guidance with regard to management of the problem. The limitations of the model used included the relatively high cost, the need for [16] South Korea Retrospective 20 17 (85) 58. 4 6 several days to produce the model, and possible alterations in size of stoma after surgery, which may be in disagreement with the 3D printed model.…”

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“…The availability of new automatic and semiautomatic software to assess tumour volume using 3D-CT imaging represent a considerable progress in this sense [14]. However, fortunately for ultrasound enthusiasts (which hopefully include our readers as well), also new US techniques are developing in parallel, also thanks to the more powerful computational capacity of computer workstations embedded in US scanners, and there is now the possibility to assess tumour response utilising 3D-printed tumour models from US images, with a quality similar to that achievable from the same models obtained from CT images [15]. Obviously much work is still needed, but the potential to combine CEUS, elastography and most importantly 3D-US with automatic reconstruction of the tumor volume and contrast perfusion in one single equipment with high computational capacity is a good prelude to a significant contribution of US in this field.…”