title: Intraoperative sonography in patients with colorectal cancer and resectable liver metastases on preoperative FDG-PET-CT.
abstract: BACKGROUND
  Combined fluorine 18-fluorodeoxyglucose-positron emission tomography-CT imaging has been shown to be of good diagnostic value in the preoperative evaluation of patients with colorectal cancer and liver metastases. The adjunctive use of intraoperative sonography (IOUS) may have a limited impact on treatment selection in these patients.
  
  
  OBJECTIVE
  To compare the diagnostic performance of preoperative positron emission tomography (PET)-CT alone and PET-CT combined with IOUS in the evaluation of patients who are considered for curative resection of hepatic metastases from colorectal carcinoma.
  
  
  METHODS
  Patients with colorectal cancer who underwent resection of hepatic metastases and preoperative PET-CT (with or without contrast-enhanced CT) and IOUS were identified. The performance of the imaging techniques was evaluated through review of the radiologic reports, correlation with surgical and histopathologic findings, and clinical follow-up.
  
  
  RESULTS
  Thirty-one patients (mean age, 63.5 years [range, 53-82 years]) were analyzed. Fifteen patients had received preoperative chemotherapy. The mean interval between PET-CT and IOUS was 22.6 days (range, 1-56 days). In 4 cases, neither PET-CT nor IOUS correctly diagnosed the liver metastases. In all 31 patients, the sensitivity of PET-CT alone and PET-CT combined with IOUS was 63% (95% CI 44-80%) and 93% (95% CI 78-98%), respectively; the positive predictive value was 81% and 89%, respectively. In patients without preoperative chemotherapy (n = 16), the sensitivity of PET-CT alone and PET-CT combined with IOUS was 77% (95% CI 49-94%) and 100% (95% CI 79-100%), respectively. In 11 cases (35%), IOUS altered the surgical strategy.
  
  
  CONCLUSIONS
  In patients with colorectal carcinoma and potentially resectable liver metastases on preoperative PET-CT, IOUS can provide additional information that may alter decision making with regard to surgical technique.
authors.affiliation: Division of Gastroenterology and Hepatology, Department of Internal Medicine, University Hospital of Zurich, Switzerland.
authors.forename: Stephan M
authors.initials: SM
authors.lastname: Wildi
authors.forename: Christoph
authors.initials: C
authors.lastname: Gubler
authors.forename: Thomas
authors.initials: T
authors.lastname: Hany
authors.forename: Henrik
authors.initials: H
authors.lastname: Petrowsky
authors.forename: Pierre A
authors.initials: PA
authors.lastname: Clavien
authors.forename: Wolfram
authors.initials: W
authors.lastname: Jochum
authors.forename: Tilman
authors.initials: T
authors.lastname: Gerlach
authors.forename: Michael
authors.initials: M
authors.lastname: Fried
authors.forename: Beat
authors.initials: B
authors.lastname: Mullhaupt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000473:pathology*; D005260:Female; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007430:Intraoperative Care / Q000379:methods*; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D049268:Positron-Emission Tomography / Q000706:statistics & numerical data; D011237:Predictive Value of Tests; D019275:Radiopharmaceuticals; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data; D014463:Ultrasonography / Q000379:methods* / Q000706:statistics & numerical data
chemical_list: D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18