Journal of Surgical Oncology 44: 115-1 IS (1 990)
Localization of Small Liver Tumors G U O - H U I LI MD A ~ L IJIN-QING LI MU I:rorn the Department of Surgical Oncology, Tumor Hospital of Sun Yat-sen University of Medical Sciences, Cuangxhou, China
Thirty-six patients with small liver tumor were diagnosed by a-fetoprotein (AFP); sonography , and computed tomography (CT), and underwent hepatectomy . The pathological types included 23 hepatocelluler carcinoma (HCC), 1 1 hepatic cavernous hemangioma, and 2 secondary liver cancer. In 22 patients, the tumor nodules were located in the right lobe and 14 cases in the left lobe. The diagnostic accuracy rate of CT was 100% for HCC and secondary liver cancer, but for hepatic cavernous heniangioma it was only 72.2%. However, the accuracy rate of sonography was as high as 81.8% for hepatic cavernous hemangioma and only 60.4% for liver malignancies. The positive rate of AFP for the HCC patients of this series was only 66.6%. The method of intraoperative detection of small liver tumor is introduced, if the tumor was invisible grossly or nonpalpable during exploratory Iaparotoniy. In the series, 7 cases in whom the right lobe lesion was too small to be located by routine manual examination during exploratory laparotomy were detected by this method, and all small liver tumors were resected successfully. KEY WORDS: sonography, computed tomography
INTRODUCTION Following the improvement of imaging diagnosis and the development of tumor markers in recent years, more and more small liver tumors have become detectable [ 131. However, for subclinical small liver tumor without syniptonis arid signs, the differentiation between liver cancer and hepatic hemangioma is not easy. Difficulty may sometimes be encountered to locate the tumor during operation, particularly in the event of liver cancer associated with severe cirrhosis. For determining the location of small hepatic tumor intraoperatively, some investigators [ 1,2] have advocated that, during laparotomy. all hepatic ligaments be divided so that the whole liver can be examined by “double hands palpation.” In most cases, the liver tumor can be found in this way and can sonietimes be further identified by fine-needle aspiration biopsy. Other investigators have I4.51 reported that intraoperative sonography is a simple, accurate method of identifying and localizing the liver tumor. 0 1990 Wiley-Liss, Inc.
MATERIALS AND METHODS Materials From January 1984 to April 1987, 36 cases of small liver tumor ( < 5 cm) had been referred to our hospital. These cases were diagnosed by a-fetoprotein (AFP). sonography , and computed tomography (CT) and underwent hepatectomy. In this series, male 27 and female 9, age ranged from 35 to 60 years (average 47 years). Of the 23 cases of hepatocellular carcinoma (HCC), 13 had clinical symptoms as follows: 10 cases with epigastric pain and 3 cases loss of body weight. The remaining 10 cases were discovered through mass screening or routine physical examination. In the 2 secondary liver cancer
Accepted for publication April 10, 1989 Address reprint requests to Guo-hui Li, MI). Ikpartnient of Surgical Oncology. Tumor Hospital of Sun Yot-sen University of Medical Sciences, Guangzhou 510060, China.
116
Li and Li
TABLE I. Results of Detection by Various Means in 36 Patients With Small Liver Tumors Pathological t Y Pe
HCC secondary Liver cancer Hepatic cavernous heinangioma Total
CT
Sonography
No. of cases
+
23 2 II 36
15 I 9 25
cases, one metastasized from colon cancer 2 years after operation and was detected by follow-up sonography . Another case was a patient with transverse colon cancer who complained of epigastric pain 2 months after operation and whose tumor was discovered by CT. Eleven cases of hepatic cavernous hemangioma with no clinical symptoms were diagnosed by either sonography or CT. Two of the HCC patients had undergone a second hepatectomy because of tumor recurrence; in these 2 cases, both in the first and second operations, tumors were all 5 cm in size. Another 2 cases of small liver cancer had multiple foci, distributed in different lobes. One patient had 2 foci and the other patient had 3 foci; the largest tumor was 4 X 4 cm, the smallest 0.8 cm in diameter. All these tumors were surgically successfully removed.
Pathological Findings Among the 36 small liver cancer patients, 23 were HCC, 11 hepatic cavernous hemangioma, and 2 had secondary liver cancers. In the 23 cases of HCC. 19 cases were associated with cirrhosis (82.6%), while no hepatic cirrhosis was found in secondary liver cancer nor in the hepatic cavernous hemangioma patients. In 22 patients, the tumor nodules were located in the right lobe, and in 14 cases in the left lobe. The maximal diameter of the tumors was
Localization of Small Liver Tumors G U O - H U I LI MD A ~ L IJIN-QING LI MU I:rorn the Department of Surgical Oncology, Tumor Hospital of Sun Yat-sen University of Medical Sciences, Cuangxhou, China
Thirty-six patients with small liver tumor were diagnosed by a-fetoprotein (AFP); sonography , and computed tomography (CT), and underwent hepatectomy . The pathological types included 23 hepatocelluler carcinoma (HCC), 1 1 hepatic cavernous hemangioma, and 2 secondary liver cancer. In 22 patients, the tumor nodules were located in the right lobe and 14 cases in the left lobe. The diagnostic accuracy rate of CT was 100% for HCC and secondary liver cancer, but for hepatic cavernous heniangioma it was only 72.2%. However, the accuracy rate of sonography was as high as 81.8% for hepatic cavernous hemangioma and only 60.4% for liver malignancies. The positive rate of AFP for the HCC patients of this series was only 66.6%. The method of intraoperative detection of small liver tumor is introduced, if the tumor was invisible grossly or nonpalpable during exploratory Iaparotoniy. In the series, 7 cases in whom the right lobe lesion was too small to be located by routine manual examination during exploratory laparotomy were detected by this method, and all small liver tumors were resected successfully. KEY WORDS: sonography, computed tomography
INTRODUCTION Following the improvement of imaging diagnosis and the development of tumor markers in recent years, more and more small liver tumors have become detectable [ 131. However, for subclinical small liver tumor without syniptonis arid signs, the differentiation between liver cancer and hepatic hemangioma is not easy. Difficulty may sometimes be encountered to locate the tumor during operation, particularly in the event of liver cancer associated with severe cirrhosis. For determining the location of small hepatic tumor intraoperatively, some investigators [ 1,2] have advocated that, during laparotomy. all hepatic ligaments be divided so that the whole liver can be examined by “double hands palpation.” In most cases, the liver tumor can be found in this way and can sonietimes be further identified by fine-needle aspiration biopsy. Other investigators have I4.51 reported that intraoperative sonography is a simple, accurate method of identifying and localizing the liver tumor. 0 1990 Wiley-Liss, Inc.
MATERIALS AND METHODS Materials From January 1984 to April 1987, 36 cases of small liver tumor ( < 5 cm) had been referred to our hospital. These cases were diagnosed by a-fetoprotein (AFP). sonography , and computed tomography (CT) and underwent hepatectomy. In this series, male 27 and female 9, age ranged from 35 to 60 years (average 47 years). Of the 23 cases of hepatocellular carcinoma (HCC), 13 had clinical symptoms as follows: 10 cases with epigastric pain and 3 cases loss of body weight. The remaining 10 cases were discovered through mass screening or routine physical examination. In the 2 secondary liver cancer
Accepted for publication April 10, 1989 Address reprint requests to Guo-hui Li, MI). Ikpartnient of Surgical Oncology. Tumor Hospital of Sun Yot-sen University of Medical Sciences, Guangzhou 510060, China.
116
Li and Li
TABLE I. Results of Detection by Various Means in 36 Patients With Small Liver Tumors Pathological t Y Pe
HCC secondary Liver cancer Hepatic cavernous heinangioma Total
CT
Sonography
No. of cases
+
23 2 II 36
15 I 9 25
cases, one metastasized from colon cancer 2 years after operation and was detected by follow-up sonography . Another case was a patient with transverse colon cancer who complained of epigastric pain 2 months after operation and whose tumor was discovered by CT. Eleven cases of hepatic cavernous hemangioma with no clinical symptoms were diagnosed by either sonography or CT. Two of the HCC patients had undergone a second hepatectomy because of tumor recurrence; in these 2 cases, both in the first and second operations, tumors were all 5 cm in size. Another 2 cases of small liver cancer had multiple foci, distributed in different lobes. One patient had 2 foci and the other patient had 3 foci; the largest tumor was 4 X 4 cm, the smallest 0.8 cm in diameter. All these tumors were surgically successfully removed.
Pathological Findings Among the 36 small liver cancer patients, 23 were HCC, 11 hepatic cavernous hemangioma, and 2 had secondary liver cancers. In the 23 cases of HCC. 19 cases were associated with cirrhosis (82.6%), while no hepatic cirrhosis was found in secondary liver cancer nor in the hepatic cavernous hemangioma patients. In 22 patients, the tumor nodules were located in the right lobe, and in 14 cases in the left lobe. The maximal diameter of the tumors was
