2394: New criteria at contrast-enhanced intraoperative ultrasonography for differentiating the new lesions detected intraoperatively during hepatectomies for hepatocellular carcinoma

Abstract

Objectives: Contrast-enhanced intraoperative ultrasonography (CE-IOUS) seems providing information not obtainable with conventional intraoperative ultrasonography (IOUS). The aim of this study is to validate a new classification of CE-IOUS findings in resective surgery for hepatocellular carcinoma (HCC). Methods: Sixty-two consecutive patients underwent liver resection using IOUS and CE-IOUS for HCC. Patients received intravenously 4.8 mL sulphur-hexafluoride microbubbles (SonoVue®, Bracco Imaging, Italy) for CEIOUS. Pattern of enhancement, and consequent treatment was classified in three categories: A1 (resection), A2 (resection), B (no treatment). Results: IOUS detected 52 new lesions; of them, 24 showed a B-pattern at CE-IOUS, and were not removed. The remaining 28 nodules resulted at CEIOUS A1 in eight and A2 in 20; they were removed, and at histology, six A1 type nodules and 12 A2 type were HCC. The remaining 10 nodules (2 A1 and 8 A2) were regenerative nodules (4) or low grade dysplastic lesion (4), biliary hamartoma (1), and necrotic lesion (1). Conclusions: In conclusion, CEIOUS improves IOUS accuracy with a significant impact on surgical strategy and radicality, but specificity of pattern of enhancement has to be still improved although intrinsic and probably not solvable drawbacks exist in the diagnostic criterion of tumor vascularity.