Combined ultrasounds and CEA in preoperative assessment of hepatic metastases from gastrointestinal malignancies

Abstract

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.

Tests for Liver Metastases in Gastrointestinal Cancer

“…Diagnostic use of RS in gastric tumor patients, ultrasonography (US) in gastric cancer patients or US as a screen test in colorectal malignancies seems worthwhile. For US and computed tomogra phy (CT), the low values for FP% suggests a diagnostic approach in interpretation, al though 1 report seems to use both approaches [1]. Table II shows that, generally, the best test performance is achieved for tests with a change in the cutoff level.…”

“…When the clinical problem arises in patients with unspecified digestive-tract cancer (small numbers of bil iary, pancreatic, duodenal or esophageal cancer added), 4 samples make up 733 pa tients with 151 liver métastasés; incidence is 21%, range 16-23% [1,11,14,15]. Adding benign abdominal tumors, 2 samples consti tute !…”

“…3 articles report 94 pa tients with gastric cancer including 18 with liver métastasés. The incidence of liver mé tastasés is 19%, range 17-23% [1][2][3]. Only 1 series deals with patients with high probabil ity for gastric cancer as the clinical problem [4]; 43 patients including 7 with métastasés:…”

“…Tables I and II summarize evaluations for imaging and biochemical tests, respectively. In 4 articles [1,4,12,18] the data were pre sented in such detail that the cutoff levels could be manipulated in order to make the test operational, i.e. FP or FN = 0 (cf.…”

“…198 verified liver métastasés in 1,108 patients were the num bers in 10 samples drawn from the target population of patients with colorectal cancer from 8 nations: incidence is 18%, range 8-23% [1,[5][6][7][8][9][10][11][12][13] when benign disorders were added, 2 consecutive series with 302 patients revealed 43 with liver secondaries; incidence is 14%, range 14-15% [4,8],…”