Abstract:

Introduction: treatment of patients with bilobar metastatic liver disease remains an unsolved problem. Among methods of regional chemotherapy, the least studied is isolated liver chemoperfusion, which is an unpopular technique due to its high trauma and difficult reproducibility.

Aim: was to demonstrate the method of endovascular isolated liver chemoperfusion (EILHP) developed by us.

Case report: EILCP was performed using a heart-lung machine (HLM) in a patient with cancer of the rectum, stage 2 (pT3N0M0), after combined treatment (radiation therapy (SOD 60 Gy) + anterior resection of the rectum in 2007). Disease progression. Isolated metastatic liver disease (01.2021). Isolated chemoperfusion was performed endovascularly using 2-balloon catheters, which provided vascular isolation of the liver and its isolated perfusion during the procedure. Posi- tioning of balloon catheters was performed in an open way through femoral artery and vein. Perfusion was carried out for 30 minutes with chemotherapy drugs (CtD) oxaliplatin 42,5 mg/m² and irinotecan 82,5 mg/m² injected directly into the circuit.

Results: the duration of intervention was 160 minutes, intraoperative blood loss was 50 ml. During insertion and positioning of aortic balloon, a limited dissection of the aorta developed in area of left common iliac artery deviation, which did not require any intervention in postoperative period. Duration of intensive care unit stay was 1 day. There were no complications associated with aortic dissection during 3-month follow-up. Level of ALT and AST remained within reference values during entire postoperative period. No hematological toxicity was observed. Patient was discharged on the 7th day after operation in satisfactory condition.

Patient underwent control CT scan of abdominal organs, 30 days after endovascular isolated chemoperfusion of the liver. According to the RECIST scale, stabilization of tumor process was noted.

Conclusions: proposed technique of endovascular isolated liver chemoperfusion is technically feasible and safe. The use of this method may be appropriate in treatment of patients with isolated liver metastases who require dose reduction of chemotherapeutic agents due to their severe toxicity or high patient comorbidity.

Abstract:

Introduction: surgical treatment of an area of accumulation of breast microcalcifications requires the surgeon to choose the optimal method of surgery. For a long time, the gold standard of surgery was the placement of a wire needle under X-ray control and subsequent removal. In our study, we want to demonstrate one of new methods, which is based on the placement of ultrasound marks in the area of accumulation of calcifications at the preoperative stage and further removal under the control of ultrasound device.

Aim: was to make comparative analysis and estimate the effectiveness of preoperative marking with ultrasound-positive (US-positive) marks in patients with non-palpable breast neoplasms.

Material and methods: the study included 165 patients (age 32 - 71 years). Patients were divided into three groups depending on the preoperative marking. The first group: installed ultrasound-positive Gel Mark UltraCor Bard marks in the region of microcalcifications at the outpatient stage.

The second group: marking with a wire needle «DuaLok» Bard immediately before the operation.

The third group: according to results of a repeated preoperative examination, which included: unilateral mammography in two projections with marker, a skin mark was established in the projection of a non-palpable formation.

Results: study showed that when choosing a surgical treatment using ultrasound-positive marks, the risk of detecting tumor cells at edges of the resection decreases, the time of surgery is shortened, and the volume of resection of healthy breast tissue is minimized.

Study proved that marking using ultrasound-positive marks has an advantage over other methods of preoperative marking and can be implemented in medical organizations that are not equipped with x-ray equipment for marking non-palpable breast formations immediately before surgery.

References

1.     Kaprin AD, Starinsky VV, Petrova GV. The status of cancer care for the population of Russia in 2018. MNII P.A. Herzen - branch of the Federal State Budgetary Institution Scientific Research Center for Radiology of the Ministry of Health of Russia, 2019: 236 [In Russ].

2.     World Health Organization. World health statistics 2019.

https://www.who.int/gho/publications/world_health_statistics/2019/EN_WHS_2019_Main.pdf?ua=1

3.     Kaprin AD, Starinsky VV, Petrova GV. Malignant neoplasms in Russia in 2018 (morbidity and mortality). - M.: MNII them. P.A. Herzen - branch of the Federal State Budgetary Institution Scientific Research Center for Radiology of the Ministry of Health of Russia, 2019; 250 [In Russ].

4.     Manuylova OO, Pavlova TV, Didenko VV, et al. Guidelines for the use of the BI-RADS system for mammography examination. Moscow. 2017; 23 [In Russ].

5.     American College of Radiology, ACR BI-RADS Atlas 5th Edition, 2013.

6.     Bonfiglio R, Scimeca M, Urbano N, et al. Breast microcalcifications: biological and diagnostic perspectives. Future Oncol. 2018; 14(30): 3097-3099.

7.     Tardioli S, Ballesio L, Gigli S, et al. Wire-guided Localization in Non-palpable Breast Cancer: Results from Monocentric Experience. Anticancer Res. 2016; 36(5): 2423-2427.

Abstract:

Introduction: treatment of patients with primary malignant neoplasms (PMN) of head and neck remains an unsolved problem. About 70% of neoplasms are unresectable, and one-year mortality rate reaches 90%.

Aim: was to demonstrate possibilities of using the technique of isolated chemoperfusion of head and neck (ICPHN) developed by us in the experiment.

Material and methods: ICPHN was performed using the method of extracorporeal membrane oxygenation (ECMO) on two non-human primates (hamadryas baboons), 20 kg males, 12–14 years old. The open version of intervention involved performing sternotomy, cannulation of brachiocephalic arteries (BCA) and superior vena cava (SVC) with their subsequent clamping after starting parallel ECMO. The endovascular version was made by overlapping the BCA and SVC with transfemorally inserted balloon catheters. Cannulation for ECMO was performed percutaneously through the axillary artery and vein. Perfusion was carried out for 30 minutes with a chemotherapy (CP) drug carboplatin at a dose of 150 mg injected immediately into the circuit.

Results: both procedures were carried out successfully with good immediate and long-term (30 days of follow-up) results. After 10, 20 and 30 minutes from the moment of CP injection into the isolated circuit, its content in the circuit was 7-10 times, 3-3,5 times and 4-4,5 times exceeding the concentration in the systemic circulation, respectively. During the perioperative period, vital functions and laboratory parameters were within normal limits. No complications associated with both procedures were observed. All animals quickly recovered from anesthesia without signs of neurological disorders.

Conclusions: the use of isolated chemoperfusion of head and neck with carboplatin in the experiment is feasible and safe. In the head and neck contour, the concentration of CP is observed, 3-5 times higher than in the systemic circulation, and that allows a more pronounced targeted effect on tumor. Taking into account the minimally invasiveness and repeatability of the procedure, the use of endovascular isolated chemoperfusion of head and neck is more promising.

References

1.     Vleeschouwer SD. Glioblastoma. Brisbane. Codon Publications. 2017; 678.

2.     Maghami E. Multidisciplinary Care of the head and neck cancer patient. Springer International Publishing. 2018; 282.

3.     Srinivasan VM, Lang FF, Chen SR, et al. Advances in endovascular neuro-oncology: endovascular selective intra-arterial (ESIA) infusion of targeted biologic therapy for brain tumors. J Neurointerv Surg. 2020; 12(2): 197-203.

4.     Newton HB. Intra-arterial chemotherapy of primary brain tumors. Curr Treat Options Oncol. 2005; 6(6): 519-530.

5.     Klopp CT, Alford TG, Bateman J, et al. Fractionated intra-arterial chemotherapy with methyl bis amine hydrochloride; a preliminary report. Ann Surg. 1950; 4: 811-832.

6.     Creech O, Krementz ET, Ryan RF, et al. Chemotherapy of сancer: regional perfusion utilizing an extracorporeal circuit. Ann Surg. 1958; 4: 616-632.

7.     Woodhall B, Hall K, Mahaley S, et. al. Chemotherapy of brain cancer: experimental and clinical studies in localized hypothermic perfusion. Ann Surg. 1959; 4: 640-651.

8.     Feind CR, Herter F, Markowitz A. Improvements in isolation head perfusion. Am J Surg. 1963; 5: 777-782.

Abstract:

Aim: was to optimize technics of ultrasound-guided vacuum-aspiration breast biopsy at 3 and 4A categories of BI-RADS scale and subsequent maintenance of patients.

Materials and methods: vacuum-aspiration breast biopsy was performed on 100 female patients aged 23-66 years. Long acting anesthetics were used for anesthesia. After the biopsy no residual tissue was detected.

Results: in 15% of cases (n=15), complications requiring different treatment tactics were revealed. According to histological studies 97% of tumors were benign. 3 patients were diagnosed with breast cancer classified into BI-RADS category 3. For 24% (n=24) of women, long-term results were obtained in 6 months with no signs of relapse.

Conclusions: ultrasound-guided vacuum-aspiration breast biopsy is an effective technics, that doesn't require complex preparation and doesn't take a long time to conduct. With sufficient training of the operator, it is possible to effectively control the completeness of the removal of mass. Using of long acting anesthetics allows ensuring good acceptability of the procedure and providing comfort to patients.

References

1.     Papathamelis T, Heim S, Lux MP. et al. Minimally Invasive Breast Fibroadenoma Excision Using an Ultrasound-Guided Vacuum-Assisted Biopsy Device. Geburtshilfe und Frauenheilkunde 2017; (2):176-181.

2.     Lakoma A, Kim ES, Minimally invasive surgical management of benign breast lesions. Gland surgery. 2014; (2):142-8.

3.     ACR BI-RADS Atlas® 5th Edition. www.acr.org

4.     Bennett I. C. The Changing Role of Vacuum-assisted Biopsy of the Breast: A New Prototype of Minimally Invasive Breast Surgery. Clinical breast cancer. 2017; (5): 323-325

5.     Seo J, Kim SM, Jang M, et al. Ultrasound-guided cable-free 13-gauge vacuum-assisted biopsy of non-mass breast lesions. Public Library of Science one. 2017; 12 (6)

6.     Jung I, Min JK, Hee J M, et al. Ultrasonography-guided 14-gauge core biopsy of the breast: results of 7 years of experience. Ultrasonography. 2018; (1):55-62

7.     Hui-ping Huo., Wen-bo Wan., Zhi-li Wang., et al. Percutaneous Removal of Benign Breast Lesions with an Ultrasound-guided Vacuum-assisted System: Influence Factors in the Hematoma Formation. Chinese medical sciences journal. 2016; (1):31-36.

8.     Zhang YJ, Wei L, Li J., et al. Status quo and development trend of breast biopsy technology. Gland surgery. 2013; (1):15-24.

9.     Xiao-Fang He, Feng Y Jia-Huai Wen, et al. High Residual Tumor Rate for Early Breast Cancer Patients Receiving Vacuum-assisted Breast Biopsy. Journal of Cancer. 2017; 3: 490-496.

10.   Liu S, Zou JL, Zhou FL., et al. Efficacy of ultrasound-guided vacuum-assisted Mammotome excision for management of benign breast diseases: analysis of 1267 cases. Journal of Southern Medical University. 2017; (8):1121-1125.

11.   Brennan M.E., Turner R.M., Ciatto S., et al. Ductal Carcinoma in Situ at Core-Needle Biopsy: Meta-Analysis of Underestimation and Predictors of Invasive Breast Cancer. Radiology 2011; (1):119-128.

12.   Safioleas PM, Koulicheri D, Michalopoulos N, et al. The value of stereotactic vacuum assisted breast biopsy in the investigation of microcalcifications. A six-year experience with 853 patients. Journal of Balkan Union of Oncology. 2017; (2): 340-346.

Abstract:

Background: most accurate visualization of tumor, determination of stage and spread of tumor process is substantially significant for children who undergo treatment in accordance to protocols of the international SIOPEL group. According to SIOPEL criteria, patients with hepatoblastoma are stratified into risk groups based on diagnostic results. The allocation of patients into risk groups is based on the definition of the stage of the disease in the PRETEXT system (Pre-Treatment Extent of Disease - the spread of the tumor before treatment) and the level of alpha-fetoprotein (AFP)

Aim: was to present the main criteria of PRETEXT hepatoblastoma staging, based on results of magnetic resonance imaging (MRI).

Material and methods: study includes 74 patients with diagnosed hepatoblastoma aged 1 month to 14 years (median 3.1 years). All patients underwent MRI of the abdominal cavity before and after polychemotherapy (PCT) courses. MRI studies were performed on the scaner Magnetom Avanto (Siemens Healthcare) with a magnetic field strength of 1.5T

Results: hepatoblastoma staging was performed according to PRETEXT criteria. Stage I of the Pretext with lesion of one liver sector was revealed in 3 (4%) cases. Stage II of the Pretext - the presence of a tumor in two adjacent sectors was revealed in 26(35,1%) cases. Pretext III - the presence of a tumor in three adjacent sectors of the liver or in two non-adjacent liver sectors was identified in 23(31%) cases. Pretext IV - lesion of all liver sectors, was revealed in 22(29,7%) cases. Conclusions: MRI is a significantly informative method that allows to achieve data not only location, size, prevalence of the tumor process, but it also enables to give an accurate pre-operative stage evaluation using the PRETEXT system. Surgical removal of the tumor is the only way to achieve a complete cure, thus it is important to get an accurate image of the tumor, its anatomical location and determine the prevalence of the tumor process.

References  

1.      Men' T.H., Rykov M.Ju., Poljakov V.G. Zlokachestvennye novoobrazovanija u detej v Rossii: osnovnye pokazateli i tendencii. [Malignant neplasm in children in Russian Federation: tendensies and basic parameters]. Rossijskij onkologicheskijzhurnal. 2015;2:43-47 [ In Russ].

2.      Kaprin A.D., Starinskij V.V., Petrova G.V.. Zlokachestvennye novoobrazovanija v Rossii v 2015 godu (zabolevaemost' i smertnost') [Malignant neoplasms in Russian Federation in 2015 (morbidity and mortality)]. MNIOI im. P. A. Gercena. 2017; 250 s [In Russ]

3.      Hadzic N, Finegold MJ. Liver neoplasia in children. Clin Liver Dis. 2011; 15:443-462.

4.      Spector L.G., Birch J. The epidemiology of hepatoblastoma . Pediatr. Blood Cancer. 2012; 59(5):776-779.

5.      Tomlinson G.E., Kappler R. Genetics and epigenetics of hepatoblastoma. Pediatr Blood Cancer. 2012;59: 785-792

6.      Chung E.M., Lattin G.E. Jr, Cube R. et al. From the archives of the AFIP: pediatric liver masses: radiologic-pathologic correlation. Part 2. Malignant tumors. Radiographics. 2011;31:483-507.

7.      Meyers R.L. Tumors of the liver in children. Surgical Oncology. 2007;16:195-203.

8.      Jon Pritchard, Julia Brown, Elizabeth Shafford, Giorgio Perilongo, Penelope Brock, Claire Dicks-Mireaux, Jean Keeling, Angela Phillips, Anton Vos, Jack Plaschkes . Predictive Value of the Pretreatment Extent of Disease System in Hepatoblastoma: Results From the International Society of Pediatric Oncology Liver Tumor Study Group SIOPEL-1 Study. Journal of Clinical Oncology. 2005; 23(6):1245-52.

9.      Czauderna P. Hepatoblastoma throughout SIOPEL trials - clinical lessons learnt. Frontiers in Bioscience (Elite Ed). 2012; 4: 470-9.

10.    Roebuck D.J., Aronson D., Clapuyt Pet al.; International Childrhood Liver Tumor Strategy Group. 2005 PRETEXT: a revised staging system for primary malignant liver tumours of childhood developed by the SIOPEL group. PediatrRadiol. 2007; 37(2):123-32.

11.    Couinaud С. Liver anatomy: portal or biliary segmentation. Dig Surg. 1979; 16( 6):459-467.

12.    Couinaud C. The surgical anatomy of the liver revisited. Paris: Maugein&Cie, 1989:84-89. 96-101. 108-117.

13.    Kim Je. F., Filin A. V., Semenkov A. V. i dr. Hirurgija ochagovyh obrazovanij pecheni u detej: organosohranjajushhaja operacija ili transplantacija?[ Surgery of focal lesions of liver in children: organ-preserving intervention or transplantology?.] Klinicheskaja i jeksperimental'naja hirurgija. 2017;1:22-30. 

Abstract:

Aim: was to show possibilities of magnetic resonance imaging (MRI) in the detection and characterization of neoplasms of the heart.

Materials and methods: we retrospectively studied clinical cases of heart neoplasms, diagnosed and operated in Federal National Center of Cardiovascular Surgery (FNCCS) (Penza) since 2008 tc 2014. All patients on admission underwent echocardiography, after which, in some cases to clarify the topography of neoplasms and features of individual anatomy - MRI was performed. In postoperative follow-up period, control studies were conducted. In all cases, the diagnosis was histologically verified. All operated patients were discharged in satisfactory condition. We made a search and analysis of scientific literature on beam diagnostics of space-occupying lesions of heart.

Results: for the period of 6 years, in FNCCS were examined and surgical treatment of more than 30 thousand patients, of which neoplasms of the heart were detected in 25(0.08%) cases. Cardiac myxoma was diagnosed in 19(76%) patients, of whom in 2(8%) cases, the echocardiographic picture was mixed, that had required magnetic resonance imaging. MRI has also been used in 2(8%) patients with benign and malignant transformation of mesenchyoma, and in few cases (4%) rhabdomyomas, lipomatous hypertrophy, atrial septum, epithelioid leiomyoma of the uterus in the germinating atrium and metastatic melanoma. Also, in some cases, the use of MRI allowed to rule out malignancy and to identify mural thrombus. In 1 case, MRI gave, a detailed study of the morphology and localization of tumors to evaluate its spatial relationship with neighboring structures, study of three-dimensional and functional parameters of the heart. Dynamic mode (Cine-SSFP), planar and volumetric reconstruction (MPR) demonstrated the topography of tumors. That helped a broad understanding of the pre-operative pathology and surgical simplified decision-making. MRI allowed to analyze results of surgical correction and implement dynamic monitoring during the early and late postoperative period.

Conclusions: MRI in the diagnosis of tumors of the heart significantly complements echocardiography, providing a non-invasive multi-modal visualization, necessary for a comprehensive assessment of the topography of lesions, detection of individual anatomical features of intracardiac and extracardiac structures. MRI should be included in the diagnostic algorithm of tumors of the heart, including to assess occured hemodynamic changes.  

References 

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3.    Moynihan T. J. Is there such a thing as heart cancer? http: www.mayoclinic.org/heart-cancer/expert-answers/ faq-20058130.

4.    Roberts W.C. Neoplasms involving the heart, their simulators, and adverse consequences of their therapy. Bayl Univ. Med. Cent. 2001; 14:358-376.

5.    Sutsch G., Jenni R., L. von Segesser, Schneider J. Heart tumors: incidence, distribution, diagnosis exemplified by 20,305 echocardiographies. Schweiz. Med. Wochenschr. 1991; 121:621-629.

6.    Goswami K.C., Shrivastava S., Bahl V.K., et al. Cardiac myxomas: clinical and echocardiographic profile intern J. Cardiol. 1998; 63 (3):251-259.

7.    Bogaert J., Dymarkowski S., Taylor A.M. Clinical Cardiac MRI. Springer 2005; 549.

8.    Buckley O., Madan R., Kwong R., et al. Cardiac Masses, Part 1: Imaging Strategies and Technical Consideration. AJR. 2011; 197:837-841.

9.    O’Donnell D.H., Abbara S., Chaithiraphan V., et al. Cardiac Tumors: Optimal Cardiac MR Sequences and Spectrum of Imaging Appearances. AJR. 2009; 193: 377387.

10.  Finn J.P, Nael K., Deshpande V., et al. Cardiac MR imaging: state of the technology. Radiology. 2006; 241:338-354.

11.  Fussen S., De Boeck B.W., Zellweger M.J., et al Cardiovascular magnetic resonance imaging for diagnosis and clinical management of suspected cardiac masses and tumours. Eur. Heart J. 2011; 32(12):1551-1560.

12.  Belenkov Ju.N., Sinicin V.E., Ternovoj S.K. Magnitno-rezonansnaja tomografija serdca i sosudov[MRI of heart and vessels]. Vidar. 1997; 144 р [In Russ].

13.  Bokerija L.A., Malashenkov A.I., Kavsadze V. Je., Serov R.A. Kardioonkologija [Cardiology]. NCSSH im. A.N. Bakuleva RAMN. 2003; 254 р [In Russ].

14.  Burke A., Virmani R. Atlas of Tumor Pathology. Tumors of the Heart and Great Vessels. Armed Forces Institute of Pathology. 1996.

15.  Butany J., Leong S.W., Carmichael K., Komeda M. A 30-year analysis of cardiac neoplasms at autopsy. Can. J. Cardiol. 2005; 21:675-680.

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17.  Hanson E.C. Cardiac tumors: a current perspective. NY State J. Med. 1992; 92:41-42.

18.  Amano J., Kono T., Wada Y, et al. Cardiac myxoma: its origin and tumor characteristics. Ann. Thorac. Cardiovasc. Surg. 2003; 9:215-21.

19.  Araoz PA., Mulvagh S.L., Tazelaar H.D., et al. CT and MR imaging of benign primary cardiac neoplasms with echocardiographic correlation. Radiographics. 2000; 20:1303-19.

20.  Buckley O., Madan R., Kwong R., et al. Cardiac Masses, Part 2: Key Imaging Features for Diagnosis and Surgical Planning. AJR. 2011; 197:842-851.

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. 

References

1.     Machi J., Oishi A.J., Furumoto N.L., Oishi R.H. Intraoperative ultrasound. Surg. Clin. North. Am. 2004; 84:1085-1111.

2.     Torzilli G., Makuuchi M. Intraoperative ultrasonography in liver cancer. Surg. Onco.l Clin.N Am. 2003; 12: 91-103.

3.     Komarov I.G., Komov D.V., Metastazy zlokachestvennyh opuholej bez vyjavlennogo pervichnogo ochaga. [Metastases of malignant tumors without identified primary lesion.]. M, «Triada H», 2002, 63-105 [InRuss].

4.     Kruskal J.B., Kane R.A. Intraoperative  US of the liver: techniques and clinical applications. Radiographics. 2006 Jul-Aug; 26(4):1067-84. 

5.     Silas A.M., Kruskal J.B., Kane R.A. Intraoperative ultrasound. Radiol. Clin. North. Am. 2001; 39:429-448.

6.     Lordan J.T., KaranjiaN.D. ‘Close shave’in liver resection for colorectal liver metastases. Eur. J. Surg. Oncol. 2010; 36:47-51.

7.     Tinkle C.L., Haas-Kogan D. Hepatocellular carcinoma: natural history, current management, and emerging tools. Biologics. 2012; 6:207-19.

8.     Xu L.H., Cai S.J., Cai G.X., Peng W.J. Imaging diagnosis of colorectal liver metastases. World J. Gastroenterol. 2011; 17(42):4654-9.

9.     Schmidt J., Strotzer M., Fraunhofer S. et al. Intraoperative ultrasonography versus helical computed tomography and computed tomography with arterioportography in diagnosing colorectal liver metastases: lesion-by-lesion analysis. World J. Surg. 2000; 24:43-47.

10.   Kulig J., Popiela T., Ktek S., et al. Intraoperative ultrasonography in detecting. Scand. J. Surg. 2007; 96: 51-5.

11.   Hata S., Imamura H., Aoki T., et al. Value of visual inspection, bimanual palpation, and intraoperative ultrasonography during hepatic resection for liver metastases of colorectal carcinoma. World J. Surg. 2011 Dec; 35(12):2779-87.

12.   Patel N.A., Roh M.S. Utility of intraoperative liver ultrasound. Surg.Clin. North Am. 2004 Apr; 84(2):513-24.

13.   Kaczmarek B., Petka B., Ostrowski M. Usefulness of intraoperative ultrasonography of the liver in patients with colorectal adenocarcinoma. Pol. Merkur. Lekarski. 2003 Mar; 14(81):229-32.

14.   Spiliotis J., Rouanet P., Deschamps F., et al. Accuracy of intraoperative ultrasonography in diagnosing liver metastasis from colorectal cancer: evaluation with postoperative follow-up results. World J. Surg. 1992 May-Jun; 16(3):545-6.

15.   Piccolboni D., Ciccone F., Settembre A., Corcione F. Liver resection with intraoperative and laparoscopic ultrasound: report of 32 cases. Surg. Endosc. 2008; 22:1421-1426.

16.   Lordan J.T., Stenson K.M., Karanjia N.D. The value of intraoperative ultrasound and preoperative imaging, individually and in combination, in liver resection for metastatic colorectal cancer. Ann. R. Coll. Surg. Engl. 2011 Apr; 93(3):246-9.

17.   Yang S., Hongjinda S., Hanna S.S. et al. Utility of preoperative imaging in evaluating colorectal liver metastases declines over time. HPB (Oxford). 2010 Nov; 12(9):605-9.

18.   Lin L.W., Ye Z., Xue E.S., et al. Intraoperative ultrasonography in hepatobiliary surgery. Hepatobiliary Pancreat Dis Int. 2002; 1:425-8.

19.   Van Vledder M.G., Pawlik T.M., Munireddy S. et al. Factors determining the sensitivity of intraoperative ultrasonography in detecting colorectal liver metastases in the modern era. Ann. Surg. Oncol. 2010 Oct; 17(10):2756-63.

20.   Stone M.D., Kane R., Bothe A. Jr., et al. Intraoperative ultrasound imaging of the liver at the time of colorectal cancer resection. Arch. Surg. 1994; 129:431-435.

21.   Sahani D.V., Kalva S.P., Tanabe K.K. et al. Intraoperative US in patients undergoing surgery for liver neoplasms: comparison with MR imaging. Radiology. 2004 Sep; 232(3):810-4.

22.   Bloed W., van Leeuwen M.S., Borel Rinkes IH. Role of intraoperative ultrasound of the liver with improved preoperative hepatic imaging. Eur. J. Surg. 2000; 166:691-695.

23.   D'Hondt M., Vandenbroucke-Menu F., Preville- Ratelle S. et al. Is intra-operative ultrasound still useful for the detection of a hepatic tumour in the era of modern preoperative imaging? HPB (Oxford). 2011 Sep; 13(9):665-9.

24.   Kruskal J.B., Kane R.A. Intraoperative  US of the liver: techniques and clinical applications. Radiographics. 2006 Jul-Aug; 26(4):1067-84.

25.   Cabula C., Nicolosi A., Calo P.G., et al. Intraoperative ultrasonography in the diagnosis of liver metastasis from gastrointestinal neoplasms. Minerva Chir. 1993; 48:1189-92.

26.   Boutkan H., Luth W. Meyer S., et al. The impact of intraoperative ultrasonography of the liver on the surgical strategy of patients with gastrointestinal malignancies and hepatic metastases. Eur. J. Surg. Oncol. 1992; 18: 342-346.

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28.   Kruszewski W.J., Walczak J., Szajewski M., et al., The value of intraoperative liver ultrasound assessment using an intraabdominal probe during laparotomy performed for oncological reasons. Pol. Przegl. Chir. 2013 Feb 1; 85(2):78-82.

29.   Liu L., Miao R., Yang H., et al. Prognostic factors after liver resection for hepatocellular carcinoma: a single-center experience from China. Am. J. Surg. 2012, 203:741-750. 

30.   Liska V., Treska V., Holubec L., et al. Recurrence of colorectal liver metastases after surgical treatment: multifactorial study. Hepatogastroenterology. 2007 Sep; 54(78):1741-4.

31.   Tao L.Y, He X.D., Qu Q., et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: a case-control study in China. Liver Int. 2010; 30: 215-221.

32.   Kane R.A., Hughes L.A., Cua E.J., et al. The impact of intraoperative ultrasonography on surgery for liver neoplasms. J. Ultrasound Med. 1994; 13:1-6. 

33.   Solomon M.J., Stephen M.S., Gallinger S., White G.H. Does intraoperative hepatic ultrasonography change surgical decision making during liver resection? Am. J. Surg. 1994; 168:307-310.

34.   Cervone A., Sardi A., Conaway G.L. Intraoperative ultrasound (IOUS) is essential in the management of metastatic colorectal liver lesions. Am. Surg. 2000; 66:611-615.

35.   Conlon R., Jacobs M., Dasgupta D., Lodge J.P. The value of intraoperative ultrasound during hepatic resection compared with improved preoperative magnetic resonance imaging. Eur. J. Ultrasound. 2003; 16:211-216.

36.   Zacherl J., Scheuba C., Imhof M., et al. Current value of intraoperative sonography during surgery for hepatic neoplasms. World J.Surg. 2002; 26:550-554.

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