Intraoperative Ultrasound and Liver Metastasis: Diagnostic Value

Abstract

Introduction: The preoperative diagnosis of liver metastases has improved in recent years with CT and MRI. Intraoperative ultrasound can identify metastases that had gone unnoticed. Objective: Compare the number of metastases identified in preoperative radiological tests, intraoperative ultrasound findings and their histological correlation. Material and Methods: From May 2009 to September 2020, 145 cases previously evaluated in the Digestive Tumors Committee were operated. The diagnostic study was based on abdominal CT and +/- resonance. The preoperative radiological diagnosis was complemented in the surgical intervention with manual palpation and systematic intraoperative ultrasound performed in our unit by the liver surgeon. Results: During the study period, 145 cases were operated on, and 133 resections were performed in 111 patients. Eight cases with portal embolization were excluded from the study due to the difficulty of evaluating them correctly. After performing an exploration of the abdominal cavity and intraoperative ultrasound detailing the number of lesions and their location, 12 patients (8%) were not resectable. The comparative results between radiological tests, intraoperative ultrasound, and histological analysis (Table 1) found that in 14 cases (11%) the ultrasound identified more metastases than the tests performed in the preoperative study. Conclusions: Intraoperative ultrasound in MH metastasis surgery must be performed thoroughly and systematically. In our experience, intraoperative ultrasound identifies 11% of liver metastases not described in preoperative imaging tests, all of them with subsequent histological confirmation.