Incidence and detection of occult hepatic metastases in colorectal carcinoma.

Finlay, I. G.; Meek, David; Gray, Helen; Duncan, John; McArdle, C. S.

doi:10.1136/bmj.284.6318.803

Cited by 85 publications

(22 citation statements)

References 7 publications

(1 reference statement)

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“…The 'true' incidence of false positive cases will more accurately be assessed after a period of follow-up since it is known that about half of occult metastases in patients with large bowel cancer declare themselves within a year of initial surgery (Olson et al, 1980). The incidence of occult metastases in patients with primary large bowel malignancy is difficult to assess but in one recent series 11/43 patients had normal livers at laparotomy but presented with metastatic disease within 2 years (Finlay et al, 1982). Whether the 'false positive' group in the present study includes patients with occult disease will be determined by follow-up examinations.…”

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confidence: 99%

Improving the detection of hepatic metastases by the use of dynamic flow scintigraphy

Leveson¹,

Wiggins²,

Nasiru³

et al. 1983

Br J Cancer

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Leeds LS9 7TFIt has been shown that ultrasound and static isotope imaging are relatively insensitive for the detection of lesions <2cm diameter (Bryan et al., 1977). CAT scanning, although apparently more sensitive than these 2 methods still appears to have a limitation in detecting small lesions in the liver (Scherer et al., 1978). However, since it has been established that intrahepatic primary or secondary tumours are associated with an increased hepatic arterial blood flow (Breedis & Young, 1953) and time-activity curves generated. The time of the peak of the kidney curve was used to indicate the division between arterial and portal inflow phases of the liver curve. The quality of the bolus injection and its distribution was assessed by examination of the rise time of the kidney curve and studies were rejected if this was greater than 8 sec. After 3-point smoothing of the liver curve the average slopes of the 2 consecutive 8-second sections on either side of the arterial/portal division were calculated. The first slope was taken to represent arterial inflow and the second slope was taken to represent the portal inflow. The hepatic perfusion index (HPI) was expressed as a fraction of the arterial inflow to the total hepatic inflow. Static scans were independently assessed (P.J.R.) as being indicative or non-indicative of the presence of hepatic metastases. The results of the static and dynamic studies were correlated with findings at laparotomy for the presence or absence of hepatic metastases, which where possible were measured. The sites of these metastases were also noted. Figure 1 shows the distribution of HPI values in the positive laparotomy group, in the group of patients with no liver metastases and in the control group. It can be seen that 24/25 patients who were in the laparotomy positive group (96%) had HPI values above the normal range, the upper limit of normal in this series being 0.42. One patient with massive hepatic replacement by tumour had an HPI value of 0.15 but interestingly had a positive static scan. In those patients known to have hepatic involvement, the sensitivity of static scanning was 64%. Nine patients in this group had normal scans, but all had abnormal HPI values. The data for the negative laparotomy group are also shown but no definitive statement can be made until the follow-up

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confidence: 99%

Improving the detection of hepatic metastases by the use of dynamic flow scintigraphy

Leveson¹,

Wiggins²,

Nasiru³

et al. 1983

Br J Cancer

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“…At laparotomy, careful inspection and palpation of the liver was carried out, and, whenever possible, biopsy of visible lesions was performed. Laparotomic inspection and palpation were taken as objective control of ultrasound scan, while no effort was made to diagnose occult hepatic metastases [Finlay et al, 1982;Angelini et al, 19831. Each patient had a preoperative assessment of the liver by ultrasound scanning, CEA-RIA, and liver-function tests (transaminases, gamma-GT, alkaline phosphatase) .…”

Section: Methodsmentioning

confidence: 99%

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

Colizza

Lupattelli

Fazio

et al. 1985

Journal of Surgical Oncology

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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.

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“…In a prospective study with liberal use of fineneedle aspiration, and surgical biopsies dur ing laparotomy, the figure was 2% as a min imum estimate [3], It is even more difficult to assess the risk for the surgeon to be wrong when finding métastasés at laparotomy; a rough estimate is 8% [3,13,24]. The search for a better arbiter is desirable and ongoing [25][26][27][28].…”

Section: Discussionmentioning

confidence: 99%