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

Abstract

BACKGROUND:

Glisson invasion by CLM is associated with a risk of margin-positive resection, leading to poor long-term outcomes after hepatectomy. This study was performed to evaluate the efficacy of intraoperative ultrasonography (IOUS) for the diagnosis of Glisson's capsule invasion by colorectal liver metastasis (CLM).

METHODS:

This prospective study involved 50 consecutive patients undergoing hepatectomy for CLM. Preoperatively, all patients had undergone gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging (EOB-MRI). During hepatectomy, a contrast agent (perflubutane) was intravenously injected and Glisson invasion was estimated based on three characteristic findings: a tumor thrombus, peripheral dilatation, and border irregularity/caliber change. The diagnostic abilities of the preoperative and intraoperative imaging studies were evaluated based on pathological examinations of resected specimens.

RESULTS:

Among 187 CLMs resected, pathological examinations proved Glisson invasion in 24 tumors (13%). IOUS revealed a tumor thrombus in 3 tumors (1.6%), peripheral dilatation in 4 (2.1%), and border irregularity and/or caliber change in 24 (12.8%). The sensitivity and specificity of IOUS with any of the above three findings for diagnosis of Glisson invasion was 79% and 96%, respectively, while preoperative EOB-MRI detected Glisson invasion in only four tumors (sensitivity/specificity, 17%/100%). The cutoff value of caliber change for diagnosis of Glisson invasion was set at 140% by receiver operating characteristic analysis. The R0 resection rates were not significantly different between patients with (82%) and without (85%) Glisson invasion.

CONCLUSIONS:

Identification of characteristic findings (tumor thrombus, peripheral dilatation, and border irregularity/caliber change) by contrast-enhanced IOUS is useful for the prediction of Glisson invasion by CLM.

• Authors: Junko Hiroyoshi, Takeaki Ishizawa, Hiroyuki Abe, Junichi Arita, Nobuhisa Akamatsu, Junichi Kaneko, Tetsuo Ushiku, Kiyoshi Hasegawa
• Journal: World journal of surgery (World J Surg) Vol. 45 Issue 4 Pg. 1168-1177 (Apr 2021) ISSN: 1432-2323 [Electronic] United States
• PMID: 33392704 (Publication Type: Journal Article)

Chemical References

• Contrast Media
• Fluorocarbons
• perfluorobutane

Topics

• Colorectal Neoplasms (diagnostic imaging)
• Contrast Media
• Fluorocarbons
• Hepatectomy
• Humans
• Liver Neoplasms (diagnostic imaging, surgery)
• Magnetic Resonance Imaging
• Prospective Studies
• Ultrasonography