Sonographic detection of peritoneal carcinomatosis: a prospective study of 37 cases

The use of sonography as an accurate modality to detect peritoneal carcinomatosis in patients with or without known malignancy was investigated.

Using ultrasound, we prospectively diagnosed peritoneal carcinomatosis in 37 patients. Findings such as liver metastases, adenomegalies, ascites and gallbladder wall thickness were first assessed. Then high resolution sonography detected omental, mesenteric, serosal and peritoneal involvement, the latter presenting as a nodule or an interruption of the anterior hyperechoic peritoneal line. Percutaneous biopsy under sonographic guidance of detected lesions, surgery or autopsy confirmed the peritoneal carcinomatosis. Sonographic search for the primary neoplasm was simultaneously done.

Carcinomatosis was proven in all 37 cases. Omental involvement was found in 36 cases (97%), serosal implants in 7 cases (19%), mesenteric involvement in 6 cases (16%), peritoneal implants in 20 cases (54%). Interruption of the anterior peritoneal line was found in 6 cases (16%), liver metastasis in 14 cases (38%), lymphadenopathies in 9 cases (24%), and significant ascites in 18 cases (49%). Gallbladder wall thickness was not a useful criterion since 12 patients (32%) had previous cholecystectomy. Biopsy of detected lesions was performed in 21 cases with 100% positive results for malignant cells. Sonography detected the primary tumor in 16 (57%) out of 28 patients without known malignancy.

Sonography was very useful for prospective detection of peritoneal carcinomatosis and the omental abnormality was the single most useful sign. Furthermore, sonographic findings, confirmed by percutaneous biopsy, prevented 24 unnecessary exploratory laparotomies.