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Laparoscopic imaging of hepatic uveal melanoma metastases 61
Preoperative imaging modalities
Patients received standard-of-care preoperative imaging modalities including ultrasound (US), computed tomography (CT, Toshiba Aquilion 16), magnetic resonance imaging (MRI, Philips Intera 1.5T) and/or positron emission tomography (PET, Philips Gemini 64 PET/CT) scans. For PET scan imaging, the radiopharmaceutical agent 18F-FDG was used.
Clinical trial
The study was approved by the Local Medical Ethics Committee of the Leiden University Medical Center and was performed in accordance with the ethical standards of the Helsinki Declaration of 1975. The study was registered in the Netherlands Trial Register as NTR3869.
RESULTS
We present three patients; all diagnosed with a solitary liver metastasis by preoperative US or CT. One patient was referred from another hospital, diagnosed with uveal melanoma and a solitary liver metastasis. Two patients were previously treated for uveal melanoma.
The rst patient was a 75-year old woman, referred from another hospital, diagnosed with uveal melanoma of the left eye. By US, CT and PET scans, a suspected 28 mm metastasis was found in the right liver lobe. She was planned for simultaneous laparoscopic metastasectomy and enucleation of the left eye. 10 mg ICG was administered intravenously 24 h before surgery. During surgery, multiple lesions of 1 to 10 mm were identi ed on the surface of the left and right liver lobe by inspection and by a clear uorescent rim around the tumors (Figure 1). One of the suspected lesions proved to be malignant, and no further liver resection was performed. Enucleation of the left eye was performed, and patient was o ered systemic therapy. Patient experienced progressive disease under Dacarbazine treatment and subsequent Ipilimumab treatment during 10 months of follow-up.