Werner, Jens Martin and Zidek, Martin and Kammerer, Sylvia and da Silva, Natascha Platz Batista and Jung, Friedrich and Schlitt, Hans Jurgen and Hornung, Matthias and Jung, Ernst-Michael (2021) Intraoperative contrast-enhanced ultrasound can have a crucial role in surgical decision-making during hepato-pancreatico-biliary surgery - Analysis of impact and input. CLINICAL HEMORHEOLOGY AND MICROCIRCULATION, 78 (1). pp. 103-116. ISSN 1386-0291, 1875-8622
Full text not available from this repository. (Request a copy)Abstract
OBJECTIVE: To assess the impact and procedural input of intraoperative ultrasound (IOUS) with contrast-enhanced ultrasound (CEUS) and ultrasound elastography on surgical decision making during the procedure and consequently the outcome after hepato-pancreatico-biliary (HPB) surgery. MATERIALS AND METHODS: Data of 50 consecutive patients, who underwent HPB surgery from 04/2018 to 07/2018 were prospectively collected for this study. During surgery, IOUS with a high-resolution ultrasound device using CEUS after bolus injection of 2.4-5 ml sulphur hexafluoride microbubbles using a 6-9MHz probe and a share wave and strain elastography was performed by an experienced examiner. Process and time analysis were carried out using mobile phone timer. RESULTS: The IOUS with CEUS and elastography correctly identified 42 malignant tumors and 4 benign lesions. In 3 cases, the examination provided false positive result (identifying 3 benign lesions as malignant) and in 1 case a malignant lesion was incorrectly assessed as benign (sensitivity 97,7%, specificity 57,1%, PPV 93,3% and NPV 80%). The specific question by the surgeon could be answered successfully in 98% of the cases. In 76% of the cases, there was a modification (42%) or a fundamental change (34%) of the planned surgical approach due to the information provided by the IOUS. Within the last group, the IOUS had a major impact on therapy outcome. In 7 patients an additional tumor resection was required, in 5 patients the tumor was assessed as inoperable, and in total in 5 patients an intraoperative RFA (4/5) or postoperative RITA (1/5) was required. Regarding procedural input, there was only a slight, but significant difference between the transport and set-up times before the intraoperative use (mean: 14 min 22 s) and the return transport (mean 13 min 6 s), (p = 0,038). The average examination time was 14 minutes, which makes only one third of the overall time demand. CONCLUSION: Combination of IOUS with CEUS and elastography in oncological HPB surgery provides valuable information that affects surgical decision-making. The procedural input of about 45 minutes seems to be a good investment considering the improvement of the surgical procedure and a significant modification of the therapy approach in the majority of the cases.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | FOCAL LIVER-LESIONS; RADIOFREQUENCY ABLATION; CLINICAL-PRACTICE; DIFFERENTIAL-DIAGNOSIS; EFSUMB GUIDELINES; RECOMMENDATIONS; CEUS; ACCURACY; AFSUMB; Surgical decision-making; hepato-pancreatico-biliary surgery; CEUS; elastography |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Chirurgie Medicine > Lehrstuhl für Röntgendiagnostik |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 19 Jul 2022 11:54 |
| Last Modified: | 19 Jul 2022 11:54 |
| URI: | https://pred.uni-regensburg.de/id/eprint/45874 |
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