Narrow-band Imaging Examination of Microvascular Architecture of Subcapsular Hepatic Tumors

Abstract

BackgroundIntraoperative ultrasonography is the golden standard method for evaluation of liver tumors during hepatectomy. However, in laparoscopic surgery, accurate assessment of tumors may be difficult, particularly if the lesion is located nearby the liver surface because of the challenges in handling the intraoperative ultrasound and the lack of tactile sensation. In this study, we demonstrate the preliminary results of examining the microvascular architecture of subcapsular hepatic tumors using laparoscopic narrow-band imaging (NBI) to distinguish between malignant and benign tumors. Materials and MethodsThirty-five lesions were examined by NBI during laparoscopic hepatectomy for the presence of abnormal microvasculature on the liver surface in relation to hepatic tumors from January 2016 to August 2018. The microvascular findings were correlated with tumor localization and pathological diagnosis. ResultsThe 35 examined nodules included 11 hepatocellular carcinoma, 18 colorectal liver metastasis, and six benign nodules. The mean tumor diameter was 26.3 (3-70) mm, and the distance from the liver surface to the tumor was 0.5 (0-5) mm. Microvessels on the liver surface were clearly visualized by NBI, consistent with malignant tumor localization. The tumors were thoroughly examined for the presence of three pathological microvascular features (enlargement, tortuosity, and heterogeneity). Abnormal microvascular patterns were found in 90.9% of hepatocellular carcinoma and 77.8% of colorectal liver metastasis, whereas neither normal sites nor benign lesions displayed microvascular abnormality. ConclusionsThis study suggests that observing the microvessel image on the liver surface by NBI could be useful in tumor localization and differentiation between benign and malignant lesions.