Abstract
PURPOSE: This study was designed to compare diagnostic accuracies of measuring liver enzymes, preoperative ultrasonography, surgical examination, and intraoperative ultrasonography for detection of liver metastases from colorectal cancer. METHODS: Blind, prospective comparisons of diagnostic examinations mentioned above were performed in 295 consecutive patients with colorectal cancer. An experienced ultrasonologist performed the preoperative examinations, nd results were unknown to the other experienced ultrasonologist who performed the intraoperative examinations. The latter, also was unaware of the findings by the surgeon. The presence of metastases was further assessed by ultrasonography three months postoperatively, as well as additional surgery and liver biopsy in some of the patients. RESULTS: The sensitivity of intraoperative ultrasonography (62/64) was significantly superior to that of surgical exploration (54/64) and that of preoperative ultrasonography (45/64). The lowest sensitivity was presented by liver enzymes. Bilobar metastases were detected in 42 of 46 patients by intraoperative ultrasonography but in only 33 patients by the surgeon. Intraoperative ultrasonography demonstrated the highest specificity of all examinations. CONCLUSIONS: Intraoperative ultrasonography reduces the number of patients with liver metastases from being subjected to superfluous or even harmful liver surgery, and it may increase the number in whom liver surgery will prolong life.
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References
Bradpiece HA, Benjamin IS, Halevy A, Blumgart LH. Major hepatic resection for colorectal liver metastases. Br J Surg 1987;74:324–6.
Hughes K, Scheele J, Sugerbaker PH. Surgery for colorectal cancer metastatic to the liver. Surg Clin North Am 1989;69:339–59.
Vogt P, Raab R, Ringe B, Pichlmayr R. Resection of synchronous liver metastases from colorectal cancer. World J Surg 1991;15:62–7.
Scheele J, Stangl R, Altendorf-Hofmann A, Gall FP. Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery 1991;110:13–29.
Masters A, Steger AC, Bown SG. Role of interstitial therapy in the treatment of liver cancer. Br J Surg 1991;78:518–23.
Onik G, Rubinsky B, Zemel R,et al. Ultrasound-guided hepatic cryosurgery in the treatment of metastatic colon carcinoma. Cancer 1991;67:901–7.
Nolsøe CP, Torp-Pedersen S, Burcharth F,et al. Interstitial hyperthermia of colorectal liver metastases with a US-guided Nd-YAG laser with a diffuser tip. Radiology 1993;187:333–7.
Casting D, Emond J, Bismuth H, Kunstlinger F. Utility of operative ultrasound in the surgical management of liver tumors. Ann Surg 1986;204:600–5.
Sigel B, Machi J, Kikuchi T,et al. Intraoperative ultrasound of the liver and pancreas. Adv Surg 1987;21:213–44.
Clarke MP, Kane RA, Steele G,et al. Prospective comparison of preoperative imaging and intraoperative ultrasonography in the detection of liver tumors. Surgery 1989;106:849–55.
Olsen AK. Intraoperative ultrasonography and the detection of liver metastases in patients with colorectal cancer. Br J Surg 1990;70:998–9.
Charnley RM, Morris DL, Dennison AR, Amar SS, Hardcastle JD. Detection of colorectal liver metastases using intraoperative ultrasonography. Br J Surg 1991;78:45–8.
Machi J, Isomoto H, Kurohiji T,et al. Accuracy of intraoperative ultrasonography in diagnosing liver metastases from colorectal cancer. World J Surg 1991;15:551–7.
Plant GR. Intra-operative ultrasonography. In: Gosgrove D, Meire H, Dewbury K, eds. Abdominal and general ultrasound. Edinburgh: Churchill Livingstone, 1993:243–50.
Couinaud C. Le foie, études anatomiques et chirurgicales. Paris: Masson & Cie, 1957.
Wernecke K, Henke L, Vassallo P,et al. Pathologic explanation for hypoechoic halo seen on sonograms of malignant liver tumors. A J R 1992;159:1011–6.
Choji K, Shinohara M, Nojima T,et al. Significant reduction of echogenicity of the compressed cavernous haemangioma. Acta Radiol 1988;29:317–20.
Parker GA, Lawrence W, Horsley JS,et al. Intraoperative ultrasound of the liver affects operative decision making. Ann Surg 1989;209:569–77.
Stadler J, Hölscher AH, Adolf J. Intraoperative ultrasonographic detection of occult liver metastases in colorectal cancer. Surg Endosc 1991;5:36–40.
Finlay IG, McArdle CS. Occult hepatic metastases in colorectal carcinoma. Br J Surg 1986;73:732–5.
Gunvén P, Makuuchi M, Takayasu K, Moriyama N, Yamasaki S, Hasegawa H. Preoperative imaging of liver metastases. Ann Surg 1985;202:573–9.
Machi J, Sigel B. Overview of benefits of operative ultrasonography during a ten year period. J Ultrasound Med 1989;8:647–52.
Rocklin MS, Senagore AJ, Talbott TM. Role of carcinoembryonic antigen and liver function tests in the detection of recurrent colorectal carcinoma. Dis Colon Rectum 1991;34:794–7.
Khattar SC, Torp-Pedersen ST, Lorentzen T,et al. Liver metastases: is biopsy necessary when sonographic assessment is certain? Eur J Ultrasound 1994;1:67–70.
Gozzeti G, Mazziotti A, Bolondi L, Barbara L. Intraoperative ultrasonography in hepato-biliary and pancreatic surgery: a practical guide. Dordrecht: Kluver Academic Publishers, 1989:9.
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Dr. Rafaelsen was supported by grants from The Danish Cancer Society and the Albani Foundation.
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Rafaelsen, S.R., Kronborg, O., Larsen, C. et al. Intraoperative ultrasonography in detection of hepatic metastases from colorectal cancer. Dis Colon Rectum 38, 355–360 (1995). https://doi.org/10.1007/BF02054221
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DOI: https://doi.org/10.1007/BF02054221