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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2014

01-06-2014 | Hepatobiliary Tumors

Usefulness of Contrast-Enhanced Intraoperative Ultrasound in Identifying Disappearing Liver Metastases from Colorectal Carcinoma After Chemotherapy

Authors: Junichi Arita, MD, PhD, Yoshihiro Ono, MD, PhD, Michiro Takahashi, MD, Yosuke Inoue, MD, PhD, Yu Takahashi, MD, PhD, Akio Saiura, MD, PhD

Published in: Annals of Surgical Oncology | Special Issue 3/2014

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Abstract

Background

Preoperative chemotherapy sometimes makes colorectal liver metastases disappear or diminish. Contrast-enhanced intraoperative ultrasound (CE-IOUS) using perflubutane may identify such metastases.

Methods

Among 131 consecutive patients who underwent hepatic resection, 86 had received preoperative chemotherapy. Of these patients, 72 were examined using contrast-enhanced computed tomography (CE-CT), gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI), contrast-enhanced ultrasound (CEUS), intraoperative ultrasound (IOUS), and CE-IOUS; these patients were the subject of the present study. Effects of IOUS and CE-IOUS to search for disappearing liver metastases (DLM) and tumors with a diameter of 1 cm or less based on the preoperative imaging were assessed.

Results

A total of 32 DLMs were noted in 11 patients. Four DLMs were identified using IOUS, and 16 DLMs (including the four DLMs identified using IOUS) were identified using CE-IOUS. Of the 16 DLMs that were missed using both IOUS and CE-IOUS, nine were resected using anatomical resection and seven were not resected. One of the nine resected DLMs was histologically proven to be adenocarcinoma. Three of the seven unresected DLMs showed tumor regrowth during a postoperative follow-up examination. CE-IOUS identified 79 % of the 19 DLMs that were ultimately confirmed as liver metastases, whereas IOUS identified 21 % of them (p < 0.004). Among the 202 tumors that were identified using preoperative imaging, 54 were 1 cm or less in diameter. The sensitivity of CE-IOUS for these tumors were superior to CE-CT (p < 0.04) and IOUS (p < 0.04), respectively.

Conclusions

CE-IOUS might be necessary after preoperative chemotherapy for colorectal liver metastasis.
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Metadata
Title
Usefulness of Contrast-Enhanced Intraoperative Ultrasound in Identifying Disappearing Liver Metastases from Colorectal Carcinoma After Chemotherapy
Authors
Junichi Arita, MD, PhD
Yoshihiro Ono, MD, PhD
Michiro Takahashi, MD
Yosuke Inoue, MD, PhD
Yu Takahashi, MD, PhD
Akio Saiura, MD, PhD
Publication date
01-06-2014
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue Special Issue 3/2014
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-014-3576-y

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