INTRAOPERATIVE ULTRASOUND IN THE MANAGEMENT OF LIVER NEOPLASMS

The purpose of this study was to determine the impact of intraoperativ e ultrasound (IOUS) on the management of patients with neoplasms of th e liver. Fifty-nine patients with liver neoplasms (primary, 6; metasta tic, 53) and without pre- or intraoperative evidence of extrahepatic d isease underwent laparotomy for possible liver resection. Preoperative imaging studies included external ultrasound (n = 12), magnetic reson ance imaging (n = 11), and/or computed tomography (n = 57). Intraopera tive evaluation on all patients included inspection, bimanual palpatio n, and ultrasonography. External ultrasound, magnetic resonance imagin g, and computed tomography identified all intraoperatively confirmed l iver neoplasms in 33, 45, and 67 per cent of eases, respectively. Unsu spected neoplasms were identified in 12 patients (20%) by inspection/p alpation and in 19 patients (32%) by IOUS. In eight patients (14%), th e occult neoplasms were identified only by IOUS, and in one patient th e neoplasms were identified only by inspection/palpation. Occult neopl asms identified by IOUS were characterized by small size (less than 2 cm). Findings from the intraoperative evaluation, such as unsuspected neoplasms and vascular proximity or invasion, altered the preoperative plan in 20 (34%) patients. Inspection, and particularly palpation, id entifies a number of preoperatively unsuspected liver neoplasms. Intra operative ultrasound, however, is the most sensitive method for detect ion of liver neoplasms and influences the operative management in a su bstantial number of patients.