title: Potential impact of adding endoscopic ultrasound to standard imaging procedures in the preoperative assessment of resectability in patients with liver tumors.
abstract: OBJECTIVE
  The value of endoscopic ultrasonography (EUS) in patients with liver diseases is limitedly described. The aim of this study was to evaluate the potential impact of adding EUS to standard imaging procedures in the evaluation of resectability in patients with liver tumors.
  
  
  METHODS
  Patients who, based on the findings of CT and/or MRI, had been referred for curative resection of liver tumours were studied. Each patient underwent EUS before the final assessment of resectability, which was done by laparoscopic ultrasound or laparotomy.
  
  
  RESULTS
  Sixty-four patients were included. Intended curative resection was performed in 19 (30%) patients. Thirty-five (55%) patients were considered to have non-curative malignant disease. In 10 (15%) patients, the tumor was judged to be benign and surgery was not performed. There were no complications related to EUS. The sensitivity, specificity, positive predictive value, and negative predictive value of EUS regarding prediction of non-resectability were 0.24, 0.94, 0.80 and 0.56 (tumor in right lobe), 0.50, 1.0, 1.0 and 0.75 (tumor in left lobe), and 0.60, 0.67, 0.86 and 0.33 (tumors in both lobes), respectively. Sixteen patients (25%) would have had changed their further management, if decision regarding non-resectability had been taken after EUS.
  
  
  CONCLUSIONS
  Addition of EUS to a standard imaging set-up based on CT and/or MRI would have changed the management in 25% of the patients otherwise scheduled for resection of suspected liver tumors.
authors.affiliation: Department of Surgery, Odense University Hospital, Odense, Denmark. alan.ainsworth@dadlnet.dk
authors.forename: Alan Patrick
authors.initials: AP
authors.lastname: Ainsworth
authors.forename: Torsten
authors.initials: T
authors.lastname: Pless
authors.forename: Henning Overgaard
authors.initials: HO
authors.lastname: Nielsen
mesh_terms: D000328:Adult; D000368:Aged; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D018084:Ultrasonography, Interventional; D055815:Young Adult