The role of intraoperative ultrasonography in planning the resection of hepatic neoplasms.

OBJECTIVE: Both intraoperative ultrasonography (US) and computed tomography with arterial portography (CTAP) may be used in planning segment-oriented liver resection in patients with primary or secondary hepatic neoplasms. This study was conducted to determine if intraoperative US findings substantially alter surgical plans based on CTAP findings alone. PATIENTS AND METHODS: Patients with potentially resectable hepatic lesions were considered for the study; judgement as to whether a lesion was resectable was based on a clinical evaluation and CTAP. Over the period Apr. 4, 1991, to Oct. 1, 1993, 24 consecutive patients with hepatic lesions were examined; of these, 22 (13 men and 9 women with a mean age of 60.1 years) underwent US during resection, 1 did not undergo surgery and 1 was found at surgery to have carcinomatosis. The true nature of the lesions was verified pathologically or by follow-up imaging and assays for carcinoembryonic antigen. RESULTS: The surgical plan based on CTAP findings alone was altered by the intraoperative US findings in 9 (41%) of the 22 patients. A total of 60 intrahepatic abnormalities were evaluated: 49 malignant lesions and 11 artifacts. The specificity (100%) and negative predictive value (73.3%) for intraoperative US were significantly greater than for CTAP (specificity of 9.1% and negative predictive value of 14.1%). CONCLUSION: In a substantial proportion of patients undergoing hepatic resection, intraoperative US alters the surgical plan based on CTAP and provides additional specificity in the evaluation of liver lesions. This method of imaging is therefore justified for patients undergoing liver resection.