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Liver Metastasis Echogenicity on Intraoperative Ultrasound is a Prognostic Factor after Curative Hepatic Resection
Michelle DeOliveira, Timothy M. Pawlik, Ana Gleisner, Lia Assumpto, Michael A. Choti; Surgery, Johns Hopkins Hospital, Baltimore, MD

Introduction: Survival after resection of colorectal liver metastases (CRLM) has traditionally been associated with clinicopathologic factors. We sought to examine the appearance of CRLM on intraoperative ultrasound to determine if echogenicity is a prognostic factor of outcome after curative resection of CRLM. Methods: Between 1998-2004, prospective data on IOUS appearance of CRLM was collected in 84 patients who underwent hepatic resection for CRLM. At the time of surgery, IOUS images were digitally recorded, blindly reviewed and scored for echogenicity (hypo-, iso-, or hyperechoic). Clinicopathologic factors and long-term survival were analyzed using chi-square and log-rank tests. Results: The primary tumor was located in the colon in 59 (70%) patients and the rectum in 25 (30%) patients. The median tumor number was 1 (range, 1 to 6) and the median tumor size was 5.0 cm (range, 1.5 to 9.0 cm). At the time of surgery, the ultrasound appearance of the colorectal liver metastases were hypoechoic in 35 (42%) patients, isoechoic in 37 (44%) patients, and hyperechoic in 12 (14%) patients. In patients with multiple metastases, there was a strong concordance in echogenicity among tumors in the same patient (P<.05). Patient clinicopathologic characteristics were similar among the different echogenicity types (all P>.05). At a median follow-up of 26 months, 56 patients (67%) were alive and 28 (33%) had died. The overall median actuarial survival was 43 months and 5-year survival was 30%. Patients with hypoechoic CRLM had a shorter median survival (31 months) compared with patients who had isoechoic (54 months) or hyperechoic (43 months) lesions (P=.01) (Figure). Conclusion: Patients with hypoechoic CRLM have a worse overall survival following curative hepatic resection. Echogenicity should be included as a prognostic factor when considering long-term outcome following surgery for CRLM.


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