Ultrasound marking of liver metastases: Principles, techniques and results

Transcription

1 Ultrasound marking of liver metastases: Principles, techniques and results Poster No.: C-1825 Congress: ECR 2015 Type: Educational Exhibit Authors: M. Lahkim, F. Z. Laamrani, H. En-Nouali, T. Amil, P Lacombe, M. El Hajjam ; PARIS/FR, Rabat/MA, Boulogne4 Billancourt/FR, Boulogne/FR Keywords: Metastases, Localisation, Diagnostic procedure, Ultrasound-Colour Doppler, Ultrasound, Liver, Abdomen DOI: /ecr2015/C-1825 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 14

2 Learning objectives -Expose the interest of guiding and marking liver metastases. -Know the principles,techniques and tricks to mark liver lesions by clips. Background Preoperative chemotherapy is increasingly used prior to resection of colorectal liver metastases (CLM). Some of these lesions may vanish or may be hardly detectable with intraoperative ultrasound (IOUS). we describe a new technique to mark small lesions with coils before chemotherapy, which facilitates the resection of small lesions likely to disappear after preoperative chemotherapy. B-mode ultrasound guidance or contrast enhanced ultrasound is better than CT guidance (real time guidance). It enables an adaptation to the patient's breathing movements, and especially a good control of the positioning of the needle into the lesion. This is a delicate interventional gesture, which requires mastery of using ultrasound tracking techniques, and knowledge of the equipment to use. We report two cases to illustrate the marking interests of liver metastases under ultrasound guidance in planning and guiding the postchemotherapy surgery. Images for this section: Page 2 of 14

3 Fig. 1: 47 Y-O male, sigmoid cancer, hepatic metastasis at the base line. Page 3 of 14

4 Fig. 2: hepatic metastasis disappear under chemotherapy Page 4 of 14

5 Findings and procedure details -We report two cases to illustrate the marking interests of liver metastases under ultrasound guidance in planning and guiding the post chemotherapy surgery. -First case: *47 years old male, followed for sigmoid adenocarcinoma with liver metastases including a litigious one located below the middle hepatic vein, measuring 1cm. *To treat this metastasis by secondary surgery,marking was performed by a clip under ultrasound. *This gesture is realised in angiography room, under local anesthesia. *The puncture of the metasasis has been performed by the needle of a tagging clip (ULTRACLIP II Tissue Marker). *the harpoon has been released after an injection in the lesion (fig 6,7). *A micro-coil (3mm x 2mm Type WA) can be used as an alternative to the clip, injected through a 22 gauge needle CHIBA (Chiba DCHN , Cook Bjaesverkov) introduced and stabilized in the liver in a coaxial needle stiffer; *The lesion disappear under neoadjuvant chemotherapy; but the clip has to be treated with intraoperative radiofrequency just after the left colectomy. -Second Case : (fig 10,11) *A 72 years old patient followed for a left colonic adenocarcinoma associated with liver metastasis 1cm segment VII near the cavo-hepatic confluence. This lesion was marked using the same technique, in contrast ultrasound before neoadjuvant chemotherapy. Right hepatectomy carrying the harpoon, was achieved under X-ray intraoperative control. Images for this section: Page 5 of 14

6 Fig. 3: CT: sigmoid adenocarcinoma Page 6 of 14

7 Fig. 4: MRI : liver metastasis Page 7 of 14

8 Fig. 5: metastasis vanishing under chemotherapy Page 8 of 14

9 Page 9 of 14

10 Fig. 6: plain abdominal radiography showing the harpoon Fig. 7: US: liver marking harpoon Page 10 of 14

11 Fig. 8: CT control of the marked metastasis after chemotherapy: the metastasis vanished Page 11 of 14

12 Fig. 9: MRI : before hepatectomy : control of the marked metastasis after neoadjuvent chemotherapy Page 12 of 14

13 Fig. 10: MRI control of the right hepatectomy Page 13 of 14

14 Conclusion In the literature,83% of liver metastases have disappeared in the imaging controls but persist histologically.hence, the need to stop in time chemotherapy to schedule secondary treatment (surgery or radio frequency). In fear of the disappearance of these lesions, the percutaneous marking guided by ultrasound imaging is a safe and effective technique. The decision of the identification of metastases preparing secondary treatment is taken as part of a multidisciplinary consensus meeting. The procedure is difficult and requires an experienced operator and mastering the technical tricks guide in B-mode ultrasound or contrast enhanced ultrasound. Personal information References 1-"Alex Zendel, Eylon Lahat, Yael Dreznik, Barak Bar Zakai, Rony Eshkenazy, Arie Ariche"Vanishing liver metastases"-a real challenge for liver surgeons.hepatobiliary surgery and nutrition Vol 3, No 5 (October 2014). 2- Fong Y, Cohen AM, Fortner JG, et al. Liver resection for colorectal metastases. J Clin Oncol 1997;15: Alonso Casado O1, González Moreno S, Encinas García S, Rojo Sebastián A, Olavarría Delgado A. [Hepatic metastasis marking before neoadjuvant chemotherapy for their subsequent location and resection using non-anatomical hepatectomy].cir Esp Dec;91(10): Epub 2012 Oct 2. Page 14 of 14