Department of Imaging, AC Camargo Cancer Center, Rua Professor Antônio Prudente, 211, São Paulo, Brazil.
World J Surg Oncol. 2013 Jun 14;11:138. doi: 10.1186/1477-7819-11-138.
Because of its safety, relative low cost and widespread availability, conventional ultrasound (US) is the modality of choice for initial evaluation of the liver. Following US, in patients eligible for surgery, further computed tomography and/or magnetic resonance imaging is usually recommended for surgical planning. There are no recent published series focusing on conventional abdominal US exclusively employed for the evaluation of liver nodules before surgery. The objective of this study is to evaluate the efficacy of focused conventional preoperative US in detecting liver lesions, and the impact of US findings on surgical management.
Sixty-seven noncirrhotic patients underwent surgical resection, after being previously submitted to focused liver US evaluation. US results were compared with intraoperative US (IOUS) and histology (gold standard). The IOUS was performed by the same radiologist who performed the preoperative US. Patient-by-patient and lesion-by-lesion analyses were performed.
A total of 241 lesions were depicted in 67 patients. The mean number of lesions detected per patient by US and IOUS was 2.37 and 3.37, respectively (P = 0.001). In 52.2% of patients, US and IOUS depicted the same number of liver lesions. Surgery with curative intent was conducted in 61 (91.0%) patients. Histological evaluation was obtained in 196 lesions; 155 were considered malignant. The overall lesions detection rate by US was 65.6%. For lesions <15 mm and lesions ≥15 mm, US showed a sensitivity rate of 55.3% and 75.5%, respectively.
The relatively high sensitivity rates achieved by US focused on liver evaluation, with the aim of lowering costs but not efficiency, places the method in focus again for use in the routine preoperative staging of candidates for liver resection. We suggest for preoperative evaluation that US could be associated with one section imaging method (computed tomography or magnetic resonance imaging) as routine.
由于其安全性、相对较低的成本和广泛的可用性，传统的超声（US）是肝脏初始评估的首选方式。在 US 之后，对于有手术适应证的患者，通常会推荐进一步进行计算机断层扫描和/或磁共振成像，以进行手术规划。目前尚无专门针对术前常规腹部 US 评估肝脏结节的最新发表系列研究。本研究的目的是评估术前聚焦常规 US 检测肝脏病变的功效，以及 US 结果对手术管理的影响。
67 例非肝硬化患者在接受术前聚焦肝脏 US 评估后接受了手术切除。将 US 结果与术中 US（IOUS）和组织学（金标准）进行比较。IOUS 由进行术前 US 的同一位放射科医生进行。对患者和病变进行了逐个分析。
67 例患者共显示 241 个病变。US 和 IOUS 分别检测到的每位患者的病变平均数量为 2.37 个和 3.37 个（P = 0.001）。在 52.2%的患者中，US 和 IOUS 显示的肝脏病变数量相同。有 61 例（91.0%）患者进行了根治性手术。对 196 个病变进行了组织学评估；155 个被认为是恶性的。US 的总体病变检出率为 65.6%。对于 <15mm 和 ≥15mm 的病变，US 的敏感性分别为 55.3%和 75.5%。
US 对肝脏评估的敏感性较高，旨在降低成本但不降低效率，这使得该方法再次成为肝切除术候选者常规术前分期的焦点。我们建议将 US 与一种常规的成像方法（计算机断层扫描或磁共振成像）联合用于术前评估。
