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Intraoperative (Contrast-Enhanced) Ultrasound Has the Highest Diagnostic Accuracy of Any Imaging Modality in Resection of Colorectal Liver Metastases

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Aim

Defining sensitivity, specificity, diagnostic accuracy for detection of colorectal liver metastases in imaging compared to intraoperative assessment. Defining a cutoff, where accuracy of detection is impaired.

Methods

Prospective single-institution clinical trial (clinicaltrials.gov: NCT01522209). Patients underwent CEUS, MDCT, and 3 Tesla EOB-MRI within 2 weeks preoperatively. Intraoperative palpation, IOUS, and CEIOUS were performed. A patient and lesion-based database was analyzed for accuracy of detection of CEUS, CT, MRI, and Palp/IOUS/CEIOUS combined read. Histology was standard of reference.

Results

Forty-seven high tumor load (mean 5, 4 lesions) patients were analyzed. Histopathology confirmed 264 lesions (245 malignant: 19 benign). Accuracy for detection of all lesions: CEUS 63%, CT 71%, MRI 92%, and PALP/IOUS/CEIOUS 98%. ROC analysis for lesion size showed severe impairment of accuracy in lesion detection smaller than 5mm. Intraoperative imaging was not impaired by lesion size. Patient-based analysis revealed a change of resection plan after IOUS/CEIOUS in 35% of patients.

Conclusion

At 5-mm lesion size, preoperative imaging shows a drop in accuracy of detection. In patients with multiple lesions, addition of MRI to MDCT seems useful. Accuracy of intraoperative ultrasound is not impacted by lesion size and should be mandatory. CEIOUS can improve intraoperative decision-making.

Trial Registration

Study registered with clinicaltrials.gov: NCT01522209

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Funding

This study was supported by a research grant from Asklepios ProResearch, Hamburg, Germany.

Author information

Authors and Affiliations

  1. Department of General, Visceral and Thoracic Surgery, Surgical Oncology, Klinikum Saarbruecken General Hospital, Saarbruecken, Germany

    Gregor A. Stavrou

  2. Semmelweis Medical Faculty, Asklepios Campus Hamburg, Hamburg, Germany

    Gregor A. Stavrou, Axel Stang & Karl J. Oldhafer

  3. Department of Medical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany

    Axel Stang

  4. Department of Surgery and Liver Transplantation, Royal Free Hospital, London, UK

    Dimitri A. Raptis

  5. Department of Surgery, Division of Surgical Oncology and Division of Transplant Surgery, Rush University Medical Center, Chicago, IL, USA

    Erik Schadde

  6. Institute of Physiology, University of Zürich Campus Irchel, Zürich, Switzerland

    Erik Schadde

  7. Department of Surgery, Cantonal Hospital Winterthur, Winterthur, Switzerland

    Erik Schadde

  8. Department of Radiology, Marienkrankenhaus Hamburg, Hamburg, Germany

    Martin Zeile

  9. Department of Radiology, Asklepios Hospital Barmbek, Hamburg, Germany

    Roland Brüning

  10. Department of General and Visceral Surgery, Surgical Oncology, Asklepios Hospital Barmbek, Hamburg, Germany

    Kim C. Wagner, Tessa M. Huber & Karl J. Oldhafer

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  1. Gregor A. Stavrou
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Correspondence to Gregor A. Stavrou.

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Stavrou, G.A., Stang, A., Raptis, D.A. et al. Intraoperative (Contrast-Enhanced) Ultrasound Has the Highest Diagnostic Accuracy of Any Imaging Modality in Resection of Colorectal Liver Metastases. J Gastrointest Surg 25, 3160–3169 (2021). https://doi.org/10.1007/s11605-021-04925-2

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