2002 CTOS Annual Meeting Oral Presentations — Surgery

HIGH-RESOLUTION INTRAVASCULAR ULTRASONOGRAPHY TO ASSESS VESSEL-INVASIVENESS OF SOFT TISSUE SARCOMA
[Abstract ID: 78]

Category: Surgery

Presentation: Oral

Authors: Peter Hohenberger¹, Michael Huenerbein¹

Author Institutions: ¹Division of Surgery and Surgical Oncology Charite Humboldt University at Berlin, Germany

Presenter: Peter Hohenberger
hohenberger@rrk-berlin.de

Correspondent: Peter Hohenberger
hohenberger@rrk-berlin.de
Berlin United States D-13125
Ph: +49-30-9417-1406
Fax: +49-30-9417-1439

Objectives: Detecting the extension of local spread of soft tissue sarcoma (STS) is of utmost importance for adequate resection. However, even MRI fails in correctly describing tumor invasion to neurovascular bundles. We explored, whether high-resolution (intravascular ultrasound (IVUS) improves correct assessment of vascular infiltration.

Methods: To qualify for enrollment, patients had to have a histologically confirmed STS with the tumor located close to and suspected to invade a neurovascular bundle.

Twenty-eight patients (12 f, 16 m, age 30-72 yrs) were examined. Tumors were located in the retroperitoneum (n=4), groin (n=7), thigh (n=9), popliteal fossa (n=9), lower leg (n=2), and axilla (n=1). Typing: liposarcoma (n=8), leiomyos. (n=6), MFH (n=6), synovial (n=5), MPNST (n=3), alveolar (n=1), hemangiopericytoma (n=1).
A 2.9F IVUS-catheter (12.5 MHz, Ultracross, Boston Scientific Corp.) was inserted via a side branch of the vessels exposed distant to the tumor during resection. IVUS findings were compared with intraoperative assessment and the resection specimen.

Results: In 16 patients, the vessels were resected, while 2 patients underwent subadventitial dissection, and in 10 patients the vessels were left untouched. IVUS detected 13 cases of vessel-invasive sarcoma (true positives). There were two false positives and one false negative whereas in another 12 cases no invasion could be found (true negative). Sensitivity: 92.8%, Specificity: 85.7%, positive predictive value (PPV): 86.6%, negative predictive value (NPV): 92.3%.

Conclusions: IVUS provides an excellent tool to assess vessel invasion of STS. It can be handled intraoperatively and by this way allows the surgeon to examine the region of interest exactly. High-resolution ultrasound might overcome some of the problems of local staging still being not solved by MRI.