Identification of Glisson's Capsule Invasion during Hepatectomy for Colorectal Liver Metastasis by Contrast-Enhanced Ultrasonography Using Perflubutane

Abstract

Background: The aim of this study was to evaluate efficacy of contrast-enhanced intraoperative ultrasonography (IOUS) in diagnosis of Glisson invasion in hepatectomy for colorectal liver metastasis (CLM). Methods: Subject consisted of 50 consecutive patients undergoing hepatectomy for CLM. Intraoperatively, presence or absence of Glisson invasion was estimated by IOUS with Perflubutane, based on the following four key findings on Glisson's capsule adjacent to the tumor: [Pattern-1] tumor thrombus, [2] border irregularity, [3] caliber change, and [4] peripheral dilatation. These findings were compared with results of pathological examinations. Results: Among 187 CLMs resected, Glisson invasion was proved in 24 tumors (13%; 7 tumors with macroscopically-obvious Glisson invasion and 17 tumors with microscopic Glisson invasion). Sensitivity/specificity of contrast-enhanced IOUS for diagnosis of macroscopic Glisson invasion was 43%/98% for the [Pattern-1], 14%/97% for [2], 86%/97% for [3], and 43%/98% for [4]. If presence of one or more key findings by IOUS were determined as a predictor of Glisson invasion, its sensitivity and specificity reached up to 100% and 90%, respectively. In contrast, sensitivity and specificity of preoperative contrast-enhanced MRI for Glisson invasion were respectively 29% and 97%. The proportion of R1 resection was not significantly different between CLM patients with Glisson invasion (82%) and those without Glisson invasion (85%). Conclusions: Evaluation of Glisson capsule adjacent to CLM by contrast-enhanced IOUS may be effective for estimation of Glisson invasion, which enables surgeons to divide Glisson capsule at the site free from the invasion, leading to avoid unexpected R1/R2 resection.