Peritoneoscopy with liver biopsy was routinely done as a pretreatment staging procedure in 190 patients with small-cell anaplastic carcinoma of the lung. Subtyping of the patients according to the WHO classification included 28.3% with fusiform cell type (WHO II,l), 28.9% with polygonal cell type (WHO 11, 2), 41.5% with lymphocytelike cell type (WHO II,3) and 1.3% with mixed types (WHO II,4). Liver metastases were found in 21% of the patients with adequate liver biopsy. In addition macroscopic signs of liver metastases were observed in 9%. No significant differences were observed among the histological subtypes. Liver function tests, such as alkaline phosphatase, LDH and GOT, were of little value in excluding liver metastases. On the other hand, 2 of 3 abnormal liver function tests were highly indicative of liver metastases. In patients with positive liver biopsy, 41% had liver metastases alone and 76% had no other evidence of distant metastatic disease if bone-marrow involvement identified with bone marrow examination is excluded as a staging procedure.Cancer 41:2008-2012, 1978.
S COMPARED WITH OTHER HISTOLOGICALA types of bronchogenic carcinoma, smallcell anaplastic carcinoma (SCAC) of the lung has a marked tendency to metastasize early and widely. The early metastatic potential of smallcell anaplastic carcinoma has been observed in staging procedures, including scalene lymphnode biopsy, mediastinoscopy, bone-marrow examination and peritoneoscopy. 6 3 7~8 , 1 3 Furthermore, in autopsy series, the frequency of metastases to the bones, liver, pancreas, adrenals and brain is about twice that observed in epidermoid carcinoma.' In a recent article, we discussed the value of performing bone marrow examination. In this paper, the results obtained by peri-' toneoscopy with liver biopsy and liver function tests in a consecutive series of patients with unFrom the
