Hepatic metastases from neuroendocrine tumors with a "thin slice" pathological examination: they are many more than you think...
OBJECTIVE
To prospectively compare the results of the pathologic examination including thin 3- to 4-mm thick serial slices of the surgical specimen in a well-defined anatomic part of the liver with those of 4 different liver imaging techniques. BACKGROUNDS SUMMARY DATA: Liver metastases (LM) of neuroendocrine origin are frequent and accuracy of pretherapeutic liver imaging in detecting small-sized LM is questioned, but no study has compared the different techniques used to image large liver specimens and meticulous pathologic examination.


METHODS
Eleven patients with a metastatic endocrine tumor were selected before undergoing a right hepatectomy or a left hepatectomy passing along the median hepatic vein. Before the hepatectomy, patients underwent somatostatin receptor scintigraphy, computed tomography, magnetic resonance imaging, and ultrasonography (US). An intraoperative assessment (palpation and US) was also performed. Liver specimens were systematically cut into thin serial slices, 3- to 4-mm thick. A final histologic count of the total number of LM was obtained and compared with findings from each imaging technique.


RESULTS
Compared with the final histologic count of LM, fewer than 50% of the LM were detected preoperatively. The accuracy was 24% for somatostatin receptor scintigraphy, 38% for computed tomography and US, and 49% for magnetic resonance imaging (the only imaging technique that detected half the number of LM). The size of the smallest LM was not greater than 2 mm in 54% of the patients.


CONCLUSIONS
Half the number of LM from neuroendocrine tumors are undetectable on preoperative imaging.
Elias
Dominique
D
Department of Oncologic Surgery, Institut Gustave Roussy, Cancer Center, Villejuif, France. elias@igr.fr
Lefevre
Jérémie H
JH
Duvillard
Pierre
P
Goéré
Diane
D
Dromain
Clarisse
C
Dumont
Frédéric
F
Baudin
Eric
E
D000328:Adult; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000473:pathology* / Q000556:secondary*; D010336:Pathology / Q000379:methods; D011446:Prospective Studies