Intraoperative ultrasound for liver tumor resection in children.
BACKGROUND
Primary hepatic neoplasms in children are rare tumors. All malignant and medically refractive benign primary pediatric liver tumors ultimately require surgical resection for cure. Accurate preoperative imaging including multidetector helical computerized tomography or magnetic resonance imaging (MRI) is necessary to determine resectability. In the literature intraoperative ultrasound (IOUS) has proven to be a vital adjunct to liver surgery in adults, but this is not well established in children.


METHODS
Between April 2003 and November 2014, children (<18-y-old) with a primary liver neoplasm, preoperatively evaluated with multidetector helical computerized tomography or MRI, who had IOUS used at the time of surgery were retrospectively reviewed.


RESULTS
Preoperative evaluation with high-resolution MRI and IOUS were discordant in 4 of 19 patients (21%). In one case, right hepatic vein involvement was not accurately assessed with MRI. Two cases showed tumor involvement in segment IV by MRI; however, IOUS revealed no medial segment involvement. The final patient had a large (>5 cm), solitary hepatic adenoma on MRI, but IOUS in this case revealed diffuse adenomatosis. The operative management was altered in three of these cases.


CONCLUSIONS
Although MRI can provide a detailed view of the hepatic anatomy and is an invaluable tool for preoperative planning for the pediatric patient with a primary liver neoplasm, IOUS may provide further and more up to date delineation of tumor extent and should be considered a crucial element in operative planning for hepatectomy in children.
Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
Amy E
AE
Felsted
Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
Yan
Y
Shi
Department of Radiology, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
Prakash M
PM
Masand
Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
Jed G
JG
Nuchtern
Division of Abdominal Transplantation, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas.
John A
JA
Goss
Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Texas Children's Hospital Liver Tumor Center, Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas. Electronic address: sanjeevv@bcm.edu.
Sanjeev A
SA
Vasudevan
D018248:Adenoma, Liver Cell / Q000000981:diagnostic imaging* / Q000601:surgery; D000293:Adolescent; D005260:Female; D018197:Hepatoblastoma / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D007223:Infant; D007430:Intraoperative Care; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D061330:Multidetector Computed Tomography; D012189:Retrospective Studies; D014463:Ultrasonography
Hepatic adenoma; Hepatic adenomatosis; Hepatoblastoma; Intraoperative ultrasound; Liver imaging; Pediatric liver tumor