Journal of Clinical Oncology, Vol 11, 2451-2455, Copyright © 1993 by American Society of Clinical Oncology
Inadequacy of ultrasonography for monitoring response to treatment of liver metastases
A Giovagnoni, A Piga, G Argalia, GM Giuseppetti, P Ercolani and R Cellerino
Academic Department of Radiology, University of Ancona, Italy.
PURPOSE: We prospectively evaluated the clinical efficacy of
ultrasonography (US) in monitoring the effect of medical treatment in
patients with liver metastases, by comparing serial US assessment with
serial magnetic resonance imaging (MRI) evaluation and clinical outcome in
a group of 41 patients with solid tumors. PATIENTS AND METHODS: Both
examinations were performed in patients with metastatic liver disease at
the start of a new treatment modality and monthly thereafter for 3 months;
close monitoring was prolonged beyond the third month in cases in which
there was disagreement between the two techniques and the clinical course
was not conclusive. RESULTS: Planned follow-up was completed in 37 cases.
There was limited concordance between the two examinations: in 21 cases
only (56.8%), US and MRI gave concordant information on the evolution of
hepatic metastases; in eight cases, both agreed on progression of disease
(PD), in 11 cases on stable disease (SD), and in one case each on partial
response (PR) and complete response (CR). In the remaining 16 cases
(43.2%), there was disagreement between the two examinations. On the basis
of subsequent clinical course, this discrepancy was shown to be due to US
inadequacy in 13 cases and to MRI inadequacy in one case; in two cases, the
clinical course was not conclusive. The most striking limits of US appeared
to be twofold: (1) a progressive appearance, with chemotherapy, of a
diffusely inhomogeneous structure of the liver, resulting in obscuration of
focal lesions (and a subsequent judgement of CR) in cases in which lesions
were, on the contrary, detected at MRI and usually confirmed by subsequent
clinical course; and (2) false US- determined PD in cases in which lesions
proven at baseline MRI were noted at US only after one to two courses of
therapy. CONCLUSION: We conclude that US, which is known to be inaccurate
for screening of liver metastases, is unreliable for the follow-up of
metastatic liver disease; despite its wide availability, low cost, and
noninvasiveness, critical therapeutic decisions should not be made based on
the outcome of this test.
