INTRAOPERATIVE ULTRASONOGRAPHY IN DETECTION OF HEPATIC METASTASES FROM COLORECTAL-CANCER

PURPOSE: This study was designed to compare diagnostic accuracies of m easuring liver enzymes, preoperative ultrasonography, surgical examina tion, and intraoperative ultrasonography for detection of liver metast ases from colorectal cancer. METHODS: Blind, prospective comparisons o f diagnostic examinations mentioned above were performed in 295 consec utive patients with colorectal cancer. An experienced ultrasonologist performed the preoperative examinations, and results were unknown to t he other experienced ultrasonologist who performed the intraoperative examinations. The latter, also was unaware of the findings by the surg eon. The presence of metastases was further assessed by ultrasonograph y three months postoperatively, as well as additional surgery and live r biopsy in some of the patients. RESULTS: The sensitivity of intraope rative ultrasonography (62/64) was significantly superior to that of s urgical exploration (54/64) and that of preoperative ultrasonography ( 45/64). The lowest sensitivity was presented by liver enzymes. Bilobar metastases were detected in 42 of 46 patients by intraoperative ultra sonography but in only 33 patients by the surgeon. Intraoperative ultr asonography demonstrated the highest specificity of all examinations. CONCLUSIONS: Intraoperative ultrasonography reduces the number of pati ents with liver metastases from being subjected to superfluous or even harmful liver surgery, and it may increase the number in whom liver s urgery will prolong life.