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

• Published in: Annals of surgical oncology Vol. 21; no. Suppl 3; pp. 390 - 397
• Main Authors: Arita, Junichi, Ono, Yoshihiro, Takahashi, Michiro, Inoue, Yosuke, Takahashi, Yu, Saiura, Akio
• Format: Journal Article
• Language: English
• Published: Boston Springer US 01.06.2014; Springer Nature B.V
• Subjects: Adult; Aged; Aged, 80 and over; Antibodies, Monoclonal - administration & dosage; Antibodies, Monoclonal, Humanized - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bevacizumab; Camptothecin - administration & dosage; Camptothecin - analogs & derivatives; Cetuximab; Colorectal Neoplasms - diagnostic imaging; Colorectal Neoplasms - drug therapy; Colorectal Neoplasms - pathology; Combined Modality Therapy; Contrast Media; Female; Follow-Up Studies; Gadolinium DTPA; Hepatectomy; Hepatobiliary Tumors; Humans; Intraoperative Care; Liver Neoplasms - diagnostic imaging; Liver Neoplasms - drug therapy; Liver Neoplasms - secondary; Magnetic Resonance Imaging; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Staging; Neoplasm, Residual - diagnosis; Oncology; Organoplatinum Compounds - administration & dosage; Prognosis; Retrospective Studies; Surgery; Surgical Oncology; Survival Rate; Tomography, X-Ray Computed - utilization; Ultrasonography, Interventional - utilization; Liver Metastasis; Colorectal Liver Metastasis; Preoperative Imaging; Preoperative Chemotherapy; Hepatic Resection
• ISSN: 1068-9265; 1534-4681; 1534-4681
• DOI: 10.1245/s10434-014-3576-y

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.