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Accuracy of intraoperative ultrasonography in diagnosing liver metastasis from colorectal cancer: Evaluation with postoperative follow-up results

Abstract

The accuracy of intraoperative ultrasonography in diagnosing liver metastasis was evaluated at the time of surgery and at follow-up in 189 patients with colorectal cancers. Evaluation at the time of operation revealed that the sensitivity of intraoperative ultrasonography (93.3%) was significantly (p<0.0001) higher than that of preoperative ultrasonography (41.3%), conventional computed tomography (47.1%), and surgical exploration (66.3%). Twenty-two of 104 metastatic liver tumors were detected solely by intraoperative ultrasonography in 18 patients (9.5% of total patients). These 22 tumors were small in size (4×4 mm to 15×18 mm) and nonpalpable during operation. During the postoperative follow-up period of 18 months or more (mean 35.6 months, median 37.1 months) after colorectal surgery, liver metastases that were unrecognized during surgery appeared in 13 (6.9%) patients. Re-evaluation based on these follow-up results indicated that the sensitivity of intraoperative ultrasonography decreased to 82.3%, which was still significantly (p< 0.0005) better than that of other methods. Intraoperatiye ultrasonography was capable of identifying 18 of 31 (58.1%) patients in whom liver metastases were otherwise unrecognized at the time of operation. Intraoperative ultrasonography is more accurate in diagnosing liver metastasis than traditional screening methods, and may have a beneficial impact on the management of colorectal cancer.

Résumé

La précision de l'échographie peropératoire dans la détection de métastases hépatiques a été évaluée à deux reprises chez 189 patients ayant un cancer colorectal. La sensibilité de l'échographie peropératoire était de 93.3% comparée à 41.3% pour l'échographie, 47.1% pour la tomadensitométrie préopératoire et 66.3% pour l'exploration chirurgicale (p<0.0001). Chez 18 (9.5%) patients, 22 des 104 tumeurs métastatiques n'étaient détectées que grâce à l'échographie peropératoire. Ces 22 tumeurs étaient de petite taille (4×4 mm à 15×18 mm) et n'étaient pas palpables pendant l'intervention. Parmi les patients suivis au moins 18 mois (moyen: 35.6 mois, médiane: 37.1 mois), 13 patients n'ayant pas de tumeur palpable au moment de l'opération, ont développé des métastases hépatiques. La sensibilité corrigée après suivi était toujours significativement plus élevée (82.3%) pour l'échographie peropératoire comparée aux autres méthodes (p<0.0005). L'échographie peropératoire peut identifier plus de la moitié des patients (18/31) chez lesquels la métastase reste méconnue autrement. L'échographie est plus précise que toute méthode conventionnelle dans la détection des métastases hépatiques et pourraît avoir un effet bénéfique dans le traitement global des cancers colo-rectaux.

Resumen

La precisión de la ultrasonografía intraoperatoria en el diagnóstico de metastásis hepáticas fue evaluada en el curso de dos períodos de tiempo en un grupo de 189 pacientes con cáncer colorrectal. La evaluación en el momento de la operación reveló que la sensibilidad de la ultrasonografía intraoperatoria (93.3%) fue significativamente (p<0.0001) mayor que la de la ultrasonografía preoperatoria (41.3%), la tomografía computadorizada convencional (47.1%) y la exploración quirúrgica (66.3%). Veintidós de 104 tumores metastásicos del hígado fueron detectados sólo mediante ultrasonografía intraoperatoria en 18 pacientes (9.5% del total de pacientes); tales tumores eran de tamaño pequeño (4×4 mm a 15×18 mm) y no palpables en el curso de la operación. En el seguimiento postoperatorio, de más de 18 meses (promedio 35.6 meses) después de cirugía colorrectal, las metástasis hepáticas no identificadas durante la operación se hicieron aparentes en 13 pacientes (6.9%). La reevaluación basada en los resultados del seguimiento señaló que la sensibilidad en la ultrasonografía intraoperatoria disminuyó a 82.3%, cifra todavía significativamente (p<0.0005) mejor que la de otros métodos. La ultrasonografía intraoperatoria logró identificar más de la mitad de los pacientes (18 de 31) en quienes las metástasis hepáticas no fueron identificadas en el momento de la operación. La ultranosografía intraoperatoria exhibe mayor certeza en al diagnóstico de metástasis hepáticas que los métodos tradicionales de tamizaje y puede tener un impacto beneficioso en el manejo del cáncer colorrectal.

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Correspondence to Junji Machi M.D., Ph.D..

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Machi, J., Isomoto, H., Kurohiji, T. et al. Accuracy of intraoperative ultrasonography in diagnosing liver metastasis from colorectal cancer: Evaluation with postoperative follow-up results. World J. Surg. 15, 551–556 (1991). https://doi.org/10.1007/BF01675662

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Keywords

  • Colorectal Cancer
  • Liver Metastasis
  • Metastatic Liver
  • Beneficial Impact
  • Mese