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WESTPORT, Aug 23 (Reuters Health) - Laparoscopic ultrasound is more sensitive than computed tomography (CT) in detecting primary and metastatic liver tumors, according to a report in the August issue of Archives of Surgery.
Dr. Allan E. Siperstein, of the Cleveland Clinic Foundation, in Ohio, and colleagues compared laparoscopic ultrasound and triphasic CT (noncontrast, hepatic arterial and portovenous phases) in 55 patients with a total of 222 primary and metastatic liver tumors.
The histologic diagnoses included adenocarcinoma (25 patients), metastatic neuroendocrine tumors (15), primary hepatocellular carcinoma (9), metastatic sarcoma (5), and metastatic melanoma (1).
Twenty-one (9.5%) of the tumors were missed by CT but were seen by laparoscopic ultrasound, the authors report, and resulted in upward staging of disease in 11 patients (20%). In most cases, these lesions were deeply embedded in the liver.
Tumors identified only by laparoscopic ultrasound tended to be small, ranging from 0.30 to 2.73 cm in maximum diameter, and all tumors larger than 3 cm were seen on both the preoperative CT scan and on ultrasound.
At 6 months after surgery, CT scan in 12 of 44 patients revealed multifocal recurrences that had not been apparent during laparoscopic ultrasound, the researchers observe.
"We believe that laparoscopic inspection combined with a meticulously performed laparoscopic ultrasound shows great promise as an acceptable staging procedure for potentially resectable primary and metastatic liver tumors," the authors conclude.
They do not, however, propose eliminating preoperative imaging studies. "Both CT scanning and magnetic resonance imaging," the researchers write, "are able to provide information on extrahepatic disease with more precision than laparoscopic ultrasound."
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