Drug & Device Development

Perflubutane improves intra-op ultrasound diagnosis of HCC

Last Updated: 2011-07-28 16:45:24 -0400 (Reuters Health)

By David Douglas

NEW YORK (Reuters Health) - Gaseous perflubutane (Sonazoid, GE Healthcare) increases the utility of intraoperative ultrasound during surgery for hepatocellular carcinoma (HCC), Japanese researchers reported online June 20th in Annals of Surgery.

Dr. Junichi Arita of the University of Tokyo and colleagues note that intraoperative ultrasound often finds incidental lesions, but it's difficult to tell which are malignant. Needle biopsies sometimes help, but they have a high false negative rate and can induce tumor seeding.

Intravascular contrast-enhanced intraoperative ultrasound (CE-IOUS) using gaseous sulfur hexafluoride (SonoVue) reportedly helps improve results in such cases. In the current study, the researchers tested another agent, gaseous perflubutane, which improves imaging of Kupffer cells and tumor vascularity.

Altogether 192 patients underwent fundamental intraoperative ultrasound and CE-IOUS. Two Sonazoid injections were allowed per patient. A tentative diagnosis of HCC was made when a lesion was either hypervascular during the vascular phase or hypoechoic during the Kupffer phase.

The results were confirmed up to 12 months postoperatively by means of histological examination or dynamic computed tomography findings.

The fundamental approach spotted 79 new focal liver lesions in 50 patients. Seventeen lesions (22%) were finally diagnosed as HCC. The contrast-enhanced ultrasound identified 21 additional new hypoechoic lesions in 16 patients. Of these, 14 lesions (67%) in 11 patients were finally diagnosed as HCC.

Overall, for distinguishing HCC, CE-IOUS with gaseous perflubutane had a sensitivity of 65%, a specificity of 94% and an accuracy of 87%.

The approach, the authors conclude, is harmless and is effective although the cost (about $65 per injection) puts restraints on its use.

Nevertheless Dr. Arita told Reuters Health by email, "routine use of CE-IOUS using Sonazoid would improve the sensitivity and specificity for diagnosing HCC and would improve disease-free survival rate and, as a consequence, overall survival of patients."

The researchers conclude that "such benefits will need to be confirmed in the future."

SOURCE: http://bit.ly/qGNuct

Ann Surg 2011.