Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Ann Surg Oncol. 2010 Oct;17(10):2756-63. doi: 10.1245/s10434-010-1108-y. Epub 2010 Jun 2.
With improved preoperative cross-sectional imaging, the added clinical value of intraoperative ultrasonography (IOUS) in the detection of colorectal liver metastases (CRLM) is unclear. Specifically, the ability of IOUS to detect additional liver metastases during surgery and its relationship between clinical and lesion specific ultrasonographic characteristics remains ill-defined. The purpose of the current study was to determine the association of clinical parameters and tumor echogenicity with the ability of IOUS to detect occult CRLM.
A total of 213 patients undergoing surgical exploration and IOUS for CRLM between 1998 and 2009 were included in the study. All patients underwent preoperative multidetector computed tomography (CT) imaging and lesion detection was compared with those identified by IOUS. In addition, early (<6 months) intrahepatic recurrence was used as a surrogate for residual disease (e.g., metastases that were undetected on initial IOUS). The influence of various characteristics on the rate in which additional metastases were detected and the rate of early intrahepatic recurrence was examined.
Overall, IOUS detected additional liver metastases in 10% of patients (n = 22). Detection of additional metastases was significantly higher in patients with multiple (≥4) tumors (P < 0.001) and hypoechoic tumors (P = 0.007). Of 153 patients undergoing resection only, 17 (11%) had an early intrahepatic recurrence. This was more common in patients with isoechoic metastases during IOUS (P = 0.03).
Even with the use of modern cross-sectional preoperative imaging, IOUS detects additional liver metastases in 10% of patients. In addition, the sensitivity of IOUS for detecting occult CRLM is highly dependent on the number and echogenicity of detected tumors.
随着术前横断面成像技术的提高，术中超声（IOUS）在结直肠癌肝转移（CRLM）检测中的附加临床价值尚不清楚。具体来说，IOUS 在手术中检测额外肝转移的能力及其与临床和病变特异性超声特征之间的关系仍未明确。本研究的目的是确定临床参数和肿瘤回声与 IOUS 检测隐匿性 CRLM 能力之间的关系。
共纳入 1998 年至 2009 年期间因 CRLM 接受手术探查和 IOUS 的 213 例患者。所有患者均接受术前多排 CT（CT）成像，将病变检测结果与 IOUS 识别的结果进行比较。此外，早期（<6 个月）肝内复发作为残留疾病的替代指标（例如，在初始 IOUS 上未检测到的转移灶）。检查了各种特征对检测到额外转移灶的比率和早期肝内复发的比率的影响。
总体而言，IOUS 在 10%的患者（n=22）中检测到额外的肝转移灶。在多发性（≥4 个）肿瘤（P<0.001）和低回声肿瘤（P=0.007）患者中，检测到额外转移灶的比例明显更高。在仅接受切除术的 153 例患者中，有 17 例（11%）发生早期肝内复发。在 IOUS 期间出现等回声转移的患者中更为常见（P=0.03）。
即使使用现代术前横断面成像，IOUS 仍能在 10%的患者中检测到额外的肝转移灶。此外，IOUS 检测隐匿性 CRLM 的灵敏度高度依赖于检测到的肿瘤的数量和回声。
