Avaliação dos tumores hepáticos através da ultra-sonografia pré e intra-operatória com o mesmo observador: estudo prospectivo / Hepatic lesions evaluation by pre and intra-operative sonography by the same operator: a prospectve study

RESUMO

A estratégia ideal para avaliação pré-operatória de ressecção de tumores hepáticos ainda não está definida. US apresenta vantagens quanto a custos, riscos e disponibilidade e limitações, sendo pior em pacientes obesos e com infiltração gordurosa hepática (IGH). Objetivos: primário: avaliar a eficácia da US na detecção de lesões hepáticas (LHs) e no planejamento de sua ressecção. Secundários: verificar se IGH e biótipo do paciente interferem na detecção das LHs e, comparar os achados da US com os da tomografia computadorizada (TC) e da ressonância magnética (RM). ... Foram avaliadas TC (24) e RM (21) e realizadas análises paciente a paciente e nódulo a nódulo ... Resultados: US e USIO detectaram mesmo número de LHs em 52,2% e a média de LHs por paciente detectadas pela US (2,37) e pela USIO (3,37) mostrou diferença estatística (p=0,001) ... Conclusões: a US mostrou sensibilidade elevada na detecção de LHs, tendo sido útil no planejamento cirúrgico dos pacientes. IGH e biótipo não interferiram na sensibilidade da US. A sensibilidade dos exames de imagem pré-operatórios (US, TC e RM) não mostrou diferença estatisticamente significativa. A US deve voltar ao foco de estudos voltados à avaliação hepática pré-operatória por imagem do fígado, sem restrições quanto ao biótipo ou presença de IGH.

ABSTRACT

The optimal imaging strategy for preoperative malignant liver lesion resection has not yet been defined. Hepatic ultrasound (US) yields advantages as low cost, lack of risks and availability, however tends to be worse for obese or patients with fatty liver infiltration (FLI). Objectives: The aim of this study was to evaluate the efficacy of US in liver lesion (LL) detection, verify its influence on surgical plan and, as a secondary objective to verify the influence of body habitus and FLI on ultrasound LL detection. Computed tomography (CT) and magnetic resonance imaging (MRI) were also compared to preoperative US. Patients and methods: Cirrhotic patients were excluded. 67 adult patients were submitted to LL resection from March/2002 to July/2007 and evaluated by US. They had colorectal cancer (51), neuroendocrine tumor (6), cholangiocarcinoma (3) and others. US results were compared to IOUS and histology (gold-standard), as well as to CT (24) and MRI (21) results. Patientby-patient and lesion-by-lesion analysis were performed. Results: in 52.2% patients US and IOUS depicted the same number of LL. The mean number of LL depicted by US (2.37) and IOUS (3.37) were statistically different (p=0.001). Curative surgery was conducted in 91.0% and surgical plan was modified after IOUS in 25.5% of patients. The sensitivity rate achieved by US (75.5%) had no statistical difference with CT (75.5%, p=0.85) or MRI (63.6%, p=0.17). The US sensitivity had no statistical difference related to overweight (71.4%) or patients with normal BMI, (84.0%) (p=0.13) nor to patients with (72.0%) or without FLI (78.1%) (p=0.49). Conclusions: The relative high sensitivity rate in LL detection by US and its contribution for LL resection associated to the fact that FLI and body habitus did not influence US sensitivity, and the lack of statistical difference for US, CT and MRI sensitivity rates; should put the method back on the focus for further studies of preoperative evaluation for LL resection candidates