RESUMO
Background: Surgery is an effective treatment for improving the survival rate of patients with colorectal cancer liver metastases (CRLM). However, accurately determining the resection margin of liver lesions during surgery remains challenging. Therefore, this study aimed to evaluate the sensitivity and predictive value of intraoperative contrast-enhanced ultrasound (CE-IOUS) in CRLM patients undergoing surgery. Methods: We performed a literature search of the PubMed, Cochrane Central Register of Controlled Trials, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang, and Weipu databases using the following search terms: metastatic liver cancer, colorectal cancer, sensitivity, contrast-enhanced intraoperative ultrasound, CE-IOUS, colorectal liver metastases, and CRLM. The search period was set from the date of establishment of the database to September 2021. Quality assessment of diagnostic accuracy studies 2 (QUADAS-2) recommended by the Cochrane Collaboration was used to assess the methodological quality of the included studies, and network meta-analysis was performed using Stata 15.0 software. Results: A total of 10 articles met the inclusion criteria. The meta-analysis results showed that the overall sensitivity and specificity of CE-IOUS were 0.96 [95% confidence interval (CI), 0.95-0.97] and 0.75 (95% CI, 0.70-0.80), respectively. The overall sensitivity and specificity of IOUS were 0.84 (95% CI, 0.82-0.86) and 0.82 (95% CI, 0.77-0.87), respectively. The area under the summary receiving operating characteristic (SROC) curves (AUCs) of CE-IOUS and IOUS were 0.9753 and 0.8590, respectively. The odds ratio (OR) and 95% CI of CE-IOUS changed the surgical margin were 0.205 and 0.071-0.465, P=0.000, the difference was statistically significant. Discussion: Based on the results of this meta-analysis, CE-IOUS improved the sensitivity and predictive value of CRLM detection compared with IOUS, and is more suitable for intraoperative planning of surgical margins. At present, it is the most sensitive imaging method available, and is recommended for use during liver resection to provide doctors with more reliable information during surgery.
RESUMO
BACKGROUND: Globally, liver cancer is the most frequent fatal malignancy. The aim of the present study was to explore the effectiveness of ultrasound (US)-guided percutaneous transhepatic puncture in patients with low-level alpha-fetoprotein (AFP) liver cancer. METHODS: A total of 300 patients with primary liver cancer (PLC) (with AFP level ≤200 ng/mL and who underwent fine-needle aspiration) who were admitted to Central South University Xiangya School of Medicine Affiliated Haikou Hospital from January 2016 to December 2020 were selected to participate in the present study. Data, such as the expression of AFP and the biological characteristics of cells related to follow-up information, were retrospectively analyzed. RESULTS: Patients with AFP content <50 ng/mL accounted for 27% of total patients. Patients with tumors <20 mm accounted for 11% of total patients. There were 88 patients with 0-50 ng/mL AFP, 75 patients with 51-100 ng/mL AFP, 57 patients with 101-150 ng/mL AFP, and 83 patients with 200 ng/mL AFP. The sensitivity of detection was ≥90%, specificity was 100%, PPV was 100%, and NPV was ≥90%. In the present study, 34 patients with tumors <20 mm in size underwent US-guided percutaneous transhepatic puncture. The sensitivity of the treatment was 93.33%, 100% specificity, 100% PPV, and 64.35% NPV. The sensitivity of US-guided percutaneous transhepatic puncture was 97.65%, 100% specificity, 100% PPV, and 55.42% NPV in 266 patients with tumor size >20 mm. Implantation and metastasis accounted for 5% of complications, and gastrointestinal bleeding accounted for 7%. Among the adverse reactions, nausea and vomiting accounted for 15%, diarrhea accounted for 10%, and bone marrow suppression accounted for 8%. CONCLUSIONS: US-guided percutaneous transhepatic puncture has high sensitivity, high specificity, and is relatively safe, with a low complication rate in patients with low-level AFP liver cancer, and has certain clinical diagnostic value.
