Intraoperative Ultrasound Staging for Colorectal Liver Metastases in the Era of Liver-Specific Magnetic Resonance Imaging: Is It Still Worthwhile?
Intraoperative Ultrasound Staging for Colorectal Liver Metastases in the Era of Liver-Specific Magnetic Resonance Imaging: Is It Still Worthwhile?
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DOI：
10.1155/2019/1369274
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发表时间：
2019-09-22
影响因子：
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通讯作者：
Ferrero, Alessandro
中科院分区：
文献类型：
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作者：
Langella, Serena;Ardito, Francesco;Ferrero, Alessandro
背景评估术中超声（IOUS）与肝脏特异性磁共振成像（MRI）在结直肠肝转移（CRLM）患者中的疗效。方法.从2010年1月至2017年12月，721例患者在肝切除术前1个月内接受了MRI作为术前检查的一部分，并被考虑纳入研究。切除术后6个月评估早期肝内复发（不包括切割表面复发），并将其视为IOUS和/或MRI未检测到的残留疾病。在逐个患者的基础上比较IOUS和MRI性能。还研究了长期结果。结果MRI共检测到2845例CRLM，每例患者CRLM的中位数为2（1-31）。术前化疗489例（67.8%）。在177例患者中，发现并切除了379个新结节。在379个新发现的结节中，317个是组织学证实的CRLM（占整个系列的11.1%）。新发CRLM的中位尺寸为6 ± 2.5 mm。128例患者（17.7%）的IOUS和MRI之间肝内血管和肿瘤的关系不同。171例患者（23.7%）术中改变了术前手术计划。总体而言，8.7%的病例发生早期肝内复发。为了评估诊断性能，排除了24例（3.3%）切割表面复发;因此，考虑分析5.4%的早期复发。IOUS诊断乳腺癌的敏感性上级于MRI（94.5%vs75.1%），特异性与MRI相似（95.7%vs95.9%）。多变量分析显示，在肝圆顶或亚glissonian和粘液组织学转移的预测因素在MRI上丢失。新发CRLM患者的5年OS（52.1% vs 37.8%，p=0.006）和DF生存率（45.1% vs 33%，p=0.002）显著低于未新发CRLM患者。结论.即使在肝脏特异性MRI时代，IOUS也可以改善CRLM切除患者的分期。术中发现新的CRLM会对肿瘤结局产生负面影响。
Background. To assess the efficacy of intraoperative ultrasound (IOUS) compared with liver-specific magnetic resonance imaging (MRI) in patients with colorectal liver metastases (CRLMs). Methods. From January 2010 to December 2017, 721 patients underwent MRI as a part of preoperative workup within 1 month before hepatectomy and were considered for the study. Early intrahepatic recurrence (relapse at cut surface excluded) was assessed 6 months after the resection and was considered as residual disease undetected by IOUS and/or MRI. IOUS and MRI performance was compared on a patient-by-patient basis. Long-term results were also studied. Results. A total of 2845 CRLMs were detected by MRI, and the median number of CRLMs per patient was 2 (1-31). Preoperative chemotherapy was administered in 489 patients (67.8%). In 177 patients, 379 new nodules were found and resected. Among 379 newly identified nodules, 317 were histologically proven CRLMs (11.1% of entire series). The median size of new CRLMs was 6 +/- 2.5 mm. Relationships between intrahepatic vessels and tumors differed between IOUS and MRI in 128 patients (17.7%). The preoperative surgical plan was intraoperatively changed for 171 patients (23.7%). Overall, early intrahepatic recurrence occurred in 8.7% of cases. To assess the diagnostic performance, 24 (3.3%) recurrences at the cut surface were excluded; thus, 5.4% of early relapses were considered for analysis. The sensitivity of IOUS was superior to MRI (94.5% vs 75.1%), while the specificity was similar (95.7% vs 95.9%). Multivariate analysis at the hepatic dome or subglissonian and mucinous histology revealed predictive factors of metastases missing at MRI. The 5-year OS (52.1% vs 37.8%, p=0.006) and DF survival (45.1% vs 33%, p=0.002) were significantly worse among patients with new CRLMs than without. Conclusions. IOUS improves staging in patients undergoing resection for CRLMs even in the era of liver-specific MRI. Intraoperative detection of new CRLMs negatively affects oncologic outcomes.