Annals of Surgical Oncology Cite Track
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
10.1245/s10434-006-9278-3
Annals of Surgical Oncology 14:1347-1355 (2007)
© 2007 Society of Surgical Oncology
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Torzilli, G.
Right arrow Articles by Montorsi, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Torzilli, G.
Right arrow Articles by Montorsi, M.

Original Article

Contrast-Enhanced Intraoperative Ultrasonography During Surgery for Hepatocellular Carcinoma in Liver Cirrhosis: Is It Useful or Useless? A Prospective Cohort Study of Our Experience

Guido Torzilli, MD, PhD, Angela Palmisano, MD, Daniele Del Fabbro, MD, Matteo Marconi, MD, Matteo Donadon, MD, Antonino Spinelli, MD, Paolo Pietro Bianchi, MD and Marco Montorsi, MD

3rd Department of Surgery, Istituto Clinico Humanitas, IRCCS, University of Milan, Via Manzoni, 56, I-20089, Rozzano, Milan, Italy

Correspondence: Address correspondence and reprint requests to: Guido Torzilli, MD, PhD; E-mail: guido.torzilli{at}unimi.it

Background: Preliminary results showed that contrast-enhanced intraoperative ultrasonography (CEIOUS) could provide information not obtainable with conventional IOUS during surgery for hepatocellular carcinoma (HCC). The aim of the study was to prospectively validate the role of CEIOUS on the basis of a larger experience and to establish a new classification that takes into account its findings.

Methods: Eighty-seven consecutive patients underwent hepatecomies for HCC. Those patients with new lesions at IOUS underwent CEIOUS: for that patients received intravenously 4.8 mL sulphurhexafluoride microbubbles. Pattern of enhancement was classified in 4 categories: A1 (full enhancement in the arterial phase and wash-out in the delayed phases), A2 (intralesional signs of neovascularization during all phases), A3 (no nodular enhancement but detectability during the liver enhancement), and B (undetectability during the liver enhancement). Resection was recommended for A1-3 nodules and no treatment for B nodules.

Results: Twenty-nine patients (33%) had 59 new lesions at IOUS and underwent CEIOUS. Twenty-seven nodules showed a B pattern at CEIOUS and were not removed; 32 nodules were classified as A1 in 5 patients, A2 in 11 patients, and A3 in 16 patients. The nodules were removed, and by histology, five A1, nine A2, and six A3 nodules were confirmed to be HCC. CEIOUS modified the operative decision making in 79% of these patients.

Conclusions: CEIOUS is useful during surgery for HCC; it complements the accuracy of IOUS and affects the radicalness of the surgical. Specificity of CEIOUS has to be further improved, although intrinsic drawbacks exist in the diagnostic criterion of tumor vascularity.

Key Words: Intraoperative ultrasonography • Hepatocellular carcinoma • Liver cirrhosis • Liver tumors • Diagnosis • Staging • Surgery • Laparoscopic ultrasonography • Contrast-enhanced ultrasound • Contrast-enhanced intraoperative ultrasound




This article has been cited by other articles:


Home page
 Ann. Surg. Oncol.Home page
D. Ribero, S. A. Curley, H. Imamura, D. C. Madoff, D. M. Nagorney, K. K. Ng, M. Donadon, V. Vilgrain, G. Torzilli, M. Roh, et al.
Selection for Resection of Hepatocellular Carcinoma and Surgical Strategy: Indications for Resection, Evaluation of Liver Function, Portal Vein Embolization, and Resection
Ann. Surg. Oncol., April 1, 2008; 15(4): 986 - 992.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2007 by the Society of Surgical Oncology.