Abstract:

Aim: was to evaluate the use of intraoperative ultrasound in examination of patients with liver cancer compared with preoperative diagnostic methods.

Materials and methods: the study involved 650 patients who received surgical treatment for the period 1998-2013 years. During surgical intervention, all patients underwent intraoperative ultrasonography (IOUS) of the liver.

Results: results of preoperative examination methods were compared with intraoperative data, IOUS and histological examination. Sensitivity and accuracy of IOUS is above all methods of preoperative diagnosis, surgical palpation and is 99.7% and 94.9%, respectively Analyzed causes of mistakes of preoperative methods. These related: long time interval before surgical intervention, diameter of formations less then 2 cm, chemotherapy, presence of concomitant cirrhosis, different location of lesions (subcapsular, on the capsular and on the diaphragm of the liver), benign or non-tumorous liver lesions. Changes of operation volume occurred in 38 % cases, 20 % of them - on the base IOUS data.

Conclusions: IOUS provides decisive diagnostic information for the surgeon during the operation which may lead to changes of operation volume, and thus affect outcomes of the disease. Contrast resolution IOUS is actual when oncological operations on the liver are made. Ultrasound professionals should be master of IOUS techniques due to the increasing necessity of its use in clinics dealing with oncological surgery of the liver. 

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Abstract:

Aim: was to determine the possibility of ultrasound in the diagnosis of hepatocellular carcinoma (HCC).

Materials and methods: the study involved 140 patients who underwent surgical treatment for the period 1998-2013 years. HCC was confirmed in 127 patients, 12 patients had benign tumors, such as hepatocellular adenoma, focal nodular hyperplasia.

Results: ultrasound features of hepatocellular carcinoma were studied. To determine the informativeness, results were compared with preoperative methods of examination, intraoperative ultrasound (IOUS) and histological examination with surgical evaluation and histologic data. Number of tumor nodules, determined by ultrasound confirmed in 74% of cases with HCC and 83,3% for benign diseases. Dimensions, which were measured by ultrasound, were confirmed in majority cases (81,1%) with HCC and 100% of cases with benign tumors. Sensitivity and specificity of ultrasound were 99,2% and 25%, CT - 96,9% and 28,6%, MRI - 100% and 33,3% respectively Aspiration biopsy showed the most balanced performance: sensitivity - 94,9%, specificity 45,4%. Lack of true negative results during angiography, IOUS and surgical evaluation did not gave possibilities to calculate the specificity and predictive value of a negative result. Sensitivity of IOUS and surgical evaluation were 98,8% and 97,6%, respectively Of all tumor markers used in the diagnostic process, none of all showed any significant sensitivity, but they were characterized by high specificity and positive predictive method predictability

Conclusions: US strategy in the diagnosis of HCC is to identify neoplasm, conducting navigation during fine-needle aspiration biopsy, specifying diagnostics during surgery. Results showed highly informative diagnostic value of ultrasound at all stages of the examination and treatment of patients with HCC. 

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