Potential for contrast-enhanced intraoperative ultrasonography with the Kupffer phase to improve and guide therapeutic strategies for hepatocellular carcinoma.

Background: Not all malignant tumors, especially in hepatocellular carcinoma (HCC) patients with cirrhosis, can be detected by preoperative imaging methods. Therefore, it is urgently necessary to improve the intraoperative detectability of HCCs. Contrast-enhanced intraoperative ultrasonography (CE-IOUS) is an effective technique for detecting and characterizing occulting HCC lesions. We aimed to evaluate the performance of CE-IOUS with the Kupffer phase in the detection and diagnosis of HCC tumors. Methods: From November 2019 to July 2022, we retrospectively enrolled 25 consecutive patients in the Department of General Surgery of Beijing Hospital who had HCC and were scheduled to undergo hepatic surgery. Preoperative magnetic resonance imaging (MRI) and contrast-enhanced ultrasound (CEUS) were performed pre-operatively. During laparoscopic or open surgery, intraoperative ultrasound (IOUS) and CE-IOUS with Sonazoid were scheduled, and the Kupffer phase was used to detect lesions. Each pathological diagnosis of neoplasm was compared with image information. Results: Among the total of 25 patients included in this study, there were 72 lesions including 57 HCCs and 15 others. The receiver operating characteristic (ROC) analysis of the four imaging methods was statistically significant. Based on the pairwise comparison of ROC curves, CE-IOUS showed the highest (96.5%) sensitivity, which did not differ significantly from MRI and CEUS (CE-IOUS Conclusions: CE-IOUS may be superior to other imaging methods in detecting potentially additional HCC lesions to be removed at the time of surgery. Thus, it can be used as an essential tool for patients with HCC to guide and modify surgical strategies.