Reply:
In response to Dr Torzilli’s specific questions in his letter, none of the additional lesions seen on contrast-enhanced intraoperative ultrasonography (CE-IOUS) was palpable, and the right lobar segments were more frequently affected than the left lobar segments.
It is our view that it is still premature to be discussing the merits of which technological requirements to adopt at this stage as this is a rapidly developing field. Dr Torzilli’s arguments to justify the usage of a lower- over a higher-frequency probe and his claim that palpation is often more accurate than ultrasound are unfounded. It is also misleading to suggest that no dedicated technology is required to enable CE-IOUS; in fact, the Italian group had used a contrast-specific software, even for a lower-frequency probe, as this is the only way CE-IOUS can be performed in real time with SonoVue. Such technology is still not widely available on most of standard ultrasound equipment in the Western world. Furthermore, the 21% alteration in surgical management in his cohort of 24 colorectal cancer patients is noticeably much lower compared with the 29.8% change in the surgical management in our study [the statement of 22.8% in his letter is inaccurate].1,2 In addition, there was a 35.1% change in the combined IOUS/CT/MRI staging following CE-IOUS in our study. The higher impact of CE-IOUS in our study may be accounted for by the superiority of the dedicated higher frequency probe and software that we used.
While these results are interesting and should encourage others to reproduce, we do need to be cautious as the current technology is still evolving and only long-term outcome studies will determine its true value in clinical practice.
Edward Leen, MD, FRCR
Pierre Carlo Ceccotti, MD
Department of Radiology
Royal Infirmary Glasgow, U.K.
e.leen@northglasgow.scot.nhs.uk
Susan Moug, MRSC
Paul Horgan, PhD
Department of Surgery
Royal Infirmary Glasgow, U.K.
e.leen@northglasgow.scot.nhs.uk
REFERENCES
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