Benefit of Contrast-Enhanced Ultrasound (CEUS) in the Follow-Up Care of Patients with Colon Cancer: A Prospective Multicenter Study

Abstract

Purpose: According to the German guidelines on colorectal cancer, unenhanced ultrasound is recommended for follow-up. On the other hand, ultrasound and radiology societies specify the use of contrast-enhanced ultrasound for ruling out liver metastases. Studies focusing on the follow-up of cancer patients are lacking. The goal of this multicenter study initiated by the German Ultrasound Society (DEGUM) was to determine the potential benefit of contrast-enhanced ultrasound in the follow-up of patients with colon cancer.

Materials and Methods: Follow-up patients with colon cancer (UICC > IIa) were investigated. As scheduled according to the German guidelines, unenhanced ultrasound was performed followed by contrast-enhanced ultrasound. All liver lesions were recorded. In case of additional metastases detected on contrast-enhanced ultrasound, contrast-enhanced CT, MRI or biopsy was performed to confirm additional liver metastases.

Results: A total of 45 liver metastases were detected in 26/290 patients (= 9 %) using unenhanced ultrasound. A further 28 metastases were detected on contrast-enhanced ultrasound in these 26 patients. In 18 patients showing no liver metastases, 40 additional metastases were detected on unenhanced ultrasound. This means that 44 patients with a total of 113 liver metastases were detected on contrast-enhanced ultrasound (p = 0.0006).

Conclusion: Contrast-enhanced ultrasound should be recommended in the follow-up of patients with colon cancer in addition to unenhanced ultrasound – the up-to-date standard.

Zusammenfassung

Ziel: Die aktuellen Empfehlungen der DGVS sehen regelmäßige sonografische Untersuchungen der Leber zum etwaigen Nachweis metachroner Lebermetastasen in der Nachsorge von Patienten mit kolorektalem Karzinom vor. Andererseits wird von Ultraschallfachgesellschaften und von radiologischer Seite grundsätzlich zum Ausschluss von Lebermetastasen eine kontrastmittelverstärkte Sonografie der Leber gefordert. Klinische Studien zu diesem Thema gibt es bis dato nicht. Ziel der DEGUM-Multizenterstudie war es den Zusatznutzen der Kontrastmittel-Sonografie in der Nachsorge von Patienten mit Kolonkarzinom zu ermitteln.

Material und Methoden: Es wurden Patienten mit Kolonkarzinom (UICC > IIa) in der Nachsorge in die Studie aufgenommen. Zu den von der DGVS-Leitlinie empfohlenen Zeitpunkten wurde eine native Sonografie der Leber durchgeführt. Zusätzlich wurde eine Kontrastmittel-Sonografie durchgeführt und die jeweilige Metastasenanzahl dokumentiert. Bei Nachweis von zusätzlichen Lebermetastasen erfolgte eine weitere Sicherung mittels CT, NMR bzw. Leberpunktion.

Ergebnisse: 290 Patienten wurden untersucht. Bei 26 Patienten wurden nativ insgesamt 45 Lebermetastasen detektiert. In der KM-Sonografie ergaben sich bei diesen 26 Patienten insgesamt 73 Lebermetastasen. Zusätzlich wurden bei weiteren 18 Patienten nur im KM-Sono Lebermetastasen (40) gefunden. D.h. nach KM-Sono ergaben sich insgesamt 44 Patienten mit 113 Leberfiliae. Bei 11 % der Patienten ergab sich folglich ein diagnostischer Zugewinn im Hinblick auf das Vorliegen von Lebermetastasen.

Schlussfolgerung: Ein signifikanter Zusatznutzen erlaubt die Empfehlung Patienten mit Kolonkarzinom in der Nachsorge nicht nur mit nativem Ultraschall sondern mit kontrastmittelverstärktem Ultraschall zu untersuchen.

Key words

ultrasound - metastases - CEUS - liver

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