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. 2018:45:33-37.
doi: 10.1016/j.ijscr.2018.03.019. Epub 2018 Mar 16.

The potentiality of laparoscopic partial liver excisional biopsy using analysis of the liver surface based on preoperative 3D simulation imaging: A case report

Shigenori Ei  1 , Osamu Itano  2 , Hideo Yoshida  3 , Hidenori Ojima  4 , Masayuki Shimoda  4 , Hiroshi Uchida  5 , Shingo Maeda  5 , Yusuke Kumamoto  6 , Satoshi Aiko  5
Affiliations

The potentiality of laparoscopic partial liver excisional biopsy using analysis of the liver surface based on preoperative 3D simulation imaging: A case report

Shigenori Ei et al. Int J Surg Case Rep. 2018.

Abstract

Introduction: The imaging diagnostics of liver tumor are difficult. There are no effective biopsy examinations for liver tumors that cannot be detected even by ultrasonography (US) and computed tomography (CT). We report a remarkably useful biopsy method for such tumors.

Presentation of case: A 67-year-old man with hepatitis C underwent gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid-enhanced magnetic resonance imaging, and the images revealed multiple delayed enhanced masses that showed high signal intensity in the hepatobiliary phase. The possibility of malignancy could not be ruled out due to the trend towards increased size of the masses. Percutaneous liver biopsy was considered impossible because CT and US could not detect the masses. Laparoscopic liver biopsy with preoperative simulation using 3D imaging was performed. The 3D imaging provided accurate information of liver surface irregularities with cirrhosis change. The tumor location was confirmed, and adequate tumor excisional biopsy was performed. Histological assessment revealed the tumor to be a focal nodular hyperplasia-like nodule.

Discussion and conclusions: Laparoscopic liver biopsy has been widely used because of its safety and accuracy. It enables accurate resection of tumors that are undetectable with CT and US by employing preoperative 3D imaging while maintaining the less-invasiveness.

Keywords: 3D simulation imaging; Case report; FNH-like lesion; Laparoscopic hepatectomy; Liver biopsy.

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Figures

Fig. 1
Fig. 1
Finding of clinical imaging (the largest tumor in segment 3 of the liver) (A–C) EOB-MRI showed delayed enhanced multiple tumors in the bilateral lobes of the liver. In the hepatobiliary phase, these nodules appeared hyperintense, and (D) the largest nodule had a central scar. (E,F) Dynamic CT did not detect any tumors.
Fig. 2
Fig. 2
(A,B) The preoperative 3D simulation and visualization was created preoperatively by the SYNAPSE VINCENT. There were multiple tumors in the bilateral lobes of the liver. (C) The salient peripheralis tumor in segment 6 that was detected with MRI imaging in the hepatobiliary phase appeared as the easiest to resect and was therefore selected for resection.
Fig. 3
Fig. 3
The location of tumors even on the surface were visually indeterminable intraoperatively. Tumor excisional biopsy using the 3D imaging provided accurate information of liver surface irregularities with cirrhotic change. (A) Simulation imaging of the target tumor. (B) The resection line was marked with an electrocautery. The asterisks denote the surface irregularities around the tumor. (C) The appearance after resection.
Fig. 4
Fig. 4
Macroscopic findings showed the tumor was 1.2 cm in diameter with a relatively clear margin against the surrounding liver tissue. (A,B) A soft green nodule was resected with a sufficient surgical margin. In the background liver, the hepatic parenchyma had a noticeable cirrhotic change. (C) The tumoral tissue is seen in the left side of the frame and the normal liver tissue is to the right. Hematoxylin and eosin stain, ×40. Compared with the background liver, the nodule showed higher cellular density. The pathological diagnosis of this nodule was an FNH-like nodule.
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