A consecutive series of 100 patients affected by gastrointestinal malignancies entered a prospective controlled study of liver metastases performed by ultrasound echography, CEA, hepatic enzymes (only alkaline phosphatase (AP) was found to be somehow significant). Laparotomic inspection and palpation were taken as objective control of ultrasound scan. Eighteen out of the 100 patients showed diffuse hepatic metastases at surgery (all controlled histologically). Hepatic echography correctly diagnosed liver metastases in 15 out of these 18 patients (= 83.8% sensitivity); two more cases (hepatic fibroangiomas) were interpreted as metastases (= 89.9% specificity). CEA-RIA assay was pathologic (greater than 10 ng/ml) in all of the 18 patients with liver metastases; 21 out of the 82 without liver metastases were CEA positive (difference of mean values statistically significant at P less than 0.01). The only significant hepatic enzyme was AP, which was pathologic in 12 out of 18 patients with liver metastases. The comparative evaluation of the three tests showed that ultrasound scanning missed three cases of diffuse hepatic metastases, which, however, were CEA positive, while AP could not help to correct such misdiagnosis.
A consecutive series of 100 patients affected by breast cancer and referred for surgical treatment were studied for the eventual spread of the tumour to the liver (echography, carcinoembryonic antigen [CEA], hepatic enzymes). Hepatic echography was positive in five cases: two also had bone and skin metastases at the time of diagnosis, and one was a case of remastectomy (these three patients died rather quickly of the disease); the remaining two patients are free of the disease 24 months after surgery and thus should be considered false-positive cases. Hepatic enzymes were not significant. The same was true for CEA except in nine cases with levels much greater than 20 ng/ml (six of these had early local and/or distant metastases). It is concluded that the usefulness of routine hepatic echography before locoregional treatment of breast cancer is rather limited. CEA much greater than 20 ng/ml may be useful prognostically.
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