title: [The impact of intra operative ultrasound in metastases liver surgery].
abstract: BACKGROUND
  Twenty-five to 50% of the patients with hepatic metastases are potential candidates for curative surgery. Intraoperative ultrasound has been employed to guide the surgery.
  
  
  OBJECTIVE
  To evaluate this method in liver surgeries and compare it to other imaging methods.
  
  
  METHODS
  Thirty-five patients (20 females, with median age of 56 years) with hepatic metastases were prospectively studied between February 2001 and July 2003. Patients had as primary tumors: colorectal cancer (24), neuroendocrine tumors (3), renal cell carcinoma (2), melanoma (2), others (4). Each patient was submitted to at least: computed tomography (30), ultrasonography (14) and magnetic resonance imaging (8). Intraoperative ultrasound was performed in all patients in order to detect liver nodules. The number and location of liver lesions were compared to preoperative results.
  
  
  RESULTS
  Intraoperative ultrasound was useful in 23 (65.6%) of the 35 surgeries and changed the planned surgical strategy in 9 (25.7%). There was a statistical significant correlation between the mean number of nodules identified by ultrasonography, computed tomography, magnetic resonance imaging and intraoperative ultrasound. We found no statistical difference between magnetic resonance imaging and intraoperative ultrasound in identifying hepatic nodules. Fifty-five nodules were submitted to histological evaluation, the gold standard method and 52/55 (94.5%) were identified by intraoperative ultrasound. Intraoperative ultrasound identified 91.6% of the smaller than 1.5 cm lesions, ultrasonography identified 15.0% of them, computed tomography 33.3% and magnetic resonance imaging 66.6%.
  
  
  CONCLUSIONS
  Intraoperative ultrasound is crucial in the evaluation and decision making in hepatic surgery. Intraoperative ultrasound presents the highest sensibility in the detection of hepatic nodules compared to other imaging methods, especially for small lesions.
authors.affiliation: Departamento de Diagnóstico por Imagem, Hospital do Câncer A.C. Camargo, São Paulo, SP. ecmpn@terra.com.br
authors.forename: Marcela Pecora
authors.initials: MP
authors.lastname: Cohen
authors.forename: Marcel Autran Cesar
authors.initials: MA
authors.lastname: Machado
authors.forename: Paulo
authors.initials: P
authors.lastname: Herman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D007813:Laparotomy / Q000379:methods; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D014057:Tomography, X-Ray Computed; D018084:Ultrasonography, Interventional