Bernatik T, Schuler A, Kunze G, Mauch M, Dietrich C F, Dirks K, Pachmann C, Börner N, Fellermann K, Menzel J, Strobel D
Dept. of Internal Medicine, Kreisklinik Ebersberg, Germany.
Dept. of Internal Medicine, Helfenstein Klinik, Geislingen, Germany.
Ultraschall Med. 2015 Dec;36(6):590-3. doi: 10.1055/s-0041-107833. Epub 2015 Nov 6.
According to the German guidelines on colorectal cancer, unenhanced ultrasound is recommended for follow-up. On the other hand, ultrasound and radiology societies specify the use of contrast-enhanced ultrasound for ruling out liver metastases. Studies focusing on the follow-up of cancer patients are lacking. The goal of this multicenter study initiated by the German Ultrasound Society (DEGUM) was to determine the potential benefit of contrast-enhanced ultrasound in the follow-up of patients with colon cancer.
Follow-up patients with colon cancer (UICC > IIa) were investigated. As scheduled according to the German guidelines, unenhanced ultrasound was performed followed by contrast-enhanced ultrasound. All liver lesions were recorded. In case of additional metastases detected on contrast-enhanced ultrasound, contrast-enhanced CT, MRI or biopsy was performed to confirm additional liver metastases.
A total of 45 liver metastases were detected in 26/290 patients (= 9 %) using unenhanced ultrasound. A further 28 metastases were detected on contrast-enhanced ultrasound in these 26 patients. In 18 patients showing no liver metastases, 40 additional metastases were detected on unenhanced ultrasound. This means that 44 patients with a total of 113 liver metastases were detected on contrast-enhanced ultrasound (p = 0.0006).
Contrast-enhanced ultrasound should be recommended in the follow-up of patients with colon cancer in addition to unenhanced ultrasound - the up-to-date standard.
根据德国结直肠癌指南，推荐使用非增强超声进行随访。另一方面，超声和放射学会规定使用对比增强超声来排除肝转移。目前缺乏针对癌症患者随访的研究。由德国超声学会（DEGUM）发起的这项多中心研究的目的是确定对比增强超声在结肠癌患者随访中的潜在益处。
对结肠癌随访患者（国际抗癌联盟分期>IIa期）进行研究。按照德国指南的规定进行安排，先进行非增强超声检查，然后进行对比增强超声检查。记录所有肝脏病变。如果在对比增强超声检查中发现额外的转移灶，则进行对比增强CT、MRI或活检以确认是否存在额外的肝转移。
在290例患者中的26例（=9%）使用非增强超声检测到共45处肝转移。在这26例患者中，对比增强超声又检测到另外28处转移灶。在18例未显示肝转移的患者中，非增强超声又检测到40处额外的转移灶。这意味着在对比增强超声检查中发现了44例患者共有113处肝转移（p = 0.0006）。
除了目前的标准——非增强超声外，在结肠癌患者的随访中还应推荐使用对比增强超声。
