Abstract
PURPOSE: The aim of this study was to prospectively assess the accuracy of the most promising imaging and tumor marker tests in liver metastasis diagnosis on follow-up of asymptomatic colorectal cancer patients during a median of 57 months after primary tumor resection. METHODS: One hundred patients, who were considered free of liver metastases after primary colorectal cancer resection and conventional follow-up, were screened for liver metastases by computerized tomography, magnetic resonance and ultrasound scans, ultrasound Doppler and isotope assessment of changes in hepatic arterial and portal venous flow, and serum estimation of carcinoembryonic antigen. Patients were followed up during a median of 41 months to identify those who developed liver metastases. RESULTS: The most sensitive technique was computerized tomography (sensitivity 0.67, specificity 0.91). Computerized tomography and magnetic resonance but not ultrasound were 100 percent accurate in differentiating liver metastases from other hepatic lesions. Techniques based on changes in hepatic arterial and portal venous flow had lower diagnostic accuracies (Doppler perfusion index, sensitivity 0.58, specificity 0.57; hepatic perfusion index, sensitivity 0.50, specificity 0.55), whereas ultrasound scanning identified only 43 percent (sensitivity 0.43, specificity 0.96) and serum carcinoembryonic antigen 33 percent (sensitivity 0.33, specificity 0.81) of patients with asymptomatic liver metastasis. Sensitivity could be improved by using tests in combination but this reduced specificity. CONCLUSIONS: Computerized tomography was the most sensitive test for asymptomatic colorectal liver metastases, but only 67 percent of affected patients were identified.
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References
B Greenway (1988) ArticleTitleHepatic metastases from colorectal cancer: Br J Surg 75 513–519
S Earlam G Glover C Fordy D Burke TG Allen-Mersh (1996) ArticleTitleRelation between tumour size, quality of life and survival in patients with colorectal liver metastases. J Clin Oncol 14 171–175
R Stangl A Altendorf-Hofman RM Charnley J Scheele (1994) ArticleTitleFactors influencing the natural history of colorectal liver metastases. Lancet 343 1405–1410
L Weiss E Grundmann J Torhorst et al. (1986) ArticleTitleHaematogenous metastatic patterns in colonic carcinoma: J Pathol 150 195–203
DA August RT Ottow PH Sugarbaker (1984) ArticleTitleClinical perspectives of human colorectal cancer metastasis. Cancer Metastasis Rev 3 303–324
E Mayhew D Glaves (1984) ArticleTitleQuantitation of tumorigenic disseminating and arrested cancer cells. Br J Cancer 50 159–166
TG Allen-Mersh S Earlam C Fordy K Abrams J Houghton (1994) ArticleTitleQuality of life and survival with continuous hepatic-artery floxuridine infusion for colorectal liver metastases. Lancet 344 1255–1260
D Schoemaker R Black L Giles J Toouli (1998) ArticleTitleYearly colonoscopy, liver CT, and chest radiography do not influence 5-year survival of colorectal cancer patients. Gastroenterology 114 211–213
M Rosen L Chan RW Beart SuffixJr P Vukasin G Anthone (1998) ArticleTitleFollow-up of colorectal cancer: Dis Colon Rectum 41 1116–1126
TG Allen-Mersh (1991) ArticleTitleImproving survival after large bowel cancer: BMJ 303 595–596
TJ Smith MM Kemeny PH Sugarbaker et al. (1982) ArticleTitleA prospective study of hepatic imaging in the detection of metastatic disease. Ann Surg 195 486–491
O Matsui T Takashima M Kadoya et al. (1987) ArticleTitleLiver metastases from colorectal cancers: Radiology 165 65–69
BA Ward DJ Miller JA Frank et al. (1989) ArticleTitleProspective evaluation of hepatic imaging in the detection of colorectal liver metastases: Surgery 105 180–187
JL Chezmar WM Rumancik AJ Megibow DH Hulnick RC Nelson ME Bernardino (1988) ArticleTitleLiver and abdominal screening in patients with cancer: Radiology 168 43–47
JT Ferrucci (1986) ArticleTitleMR imaging of the liver. AJR Am J Roentgenol 147 1103–1116
K Wernecke E Rummeny G Bongartz et al. (1991) ArticleTitleDetection of hepatic masses in patients with carcinoma: AJR Am J Roentgenol 157 731–739
IG Finlay DR Meek HW Gray et al. (1982) ArticleTitleIncidence and detection of occult hepatic metastases in colorectal cancer. BMJ 284 803–805
MM Paul JG Blomjous MA Cuesta S Meijer (1996) ArticleTitlePrognostic value of negative intraoperative ultrasonography in primary colorectal cancer. Br J Surg 83 1741–1743
E Leen WJ Angerson P O’Gorman TG Cooke CS McArdle (1996) ArticleTitleIntraoperative ultrasound in colorectal cancer patients undergoing apparently curative surgery: Clin Radiol 51 157–159
E Leen WJ Angerson H Wotherspoon B Moule TG Cooke CS McArdle (1994) ArticleTitleComparison of the Doppler perfusion index and intraoperative ultrasonography in diagnosing colorectal liver metastases: Ann Surg 220 663–667
SH Leveson PA Wiggins GR Giles A Parkin PJ Robinson (1985) ArticleTitleDeranged liver blood flow patterns in the detection of liver metastases. Br J Surg 72 128–130
A Parkin PJ Robinson P Baxter S Leveson P Wiggins GR Giles (1983) ArticleTitleLiver perfusion scintigraphy method, normal range and laparotomy correlation in 100 patients. Nucl Med Commun 4 395–402
N Wolmark HS Wieand HE Rockette et al. (1983) ArticleTitleThe prognostic significance of tumor location and bowel obstruction in Dukes B and C colorectal cancer: Ann Surg 198 743–752
BD Minsky C Mies TA Rich A Recht (1989) ArticleTitleLymphatic vessel invasion is an independent prognostic factor for survival in colorectal cancer. Int J Radiat Oncol Biol Phys 17 311–318
PA Kane V Ayton HL Walters et al. (1997) ArticleTitleMnDPDP-enhanced MR imaging of the liver. Acta Radiol 38 650–654
N Takeuchi JM Ramirez NJ Mortensen R Cobb T Whittlestone (1996) ArticleTitleIntraoperative ultrasonography in the diagnosis of hepatic metastases during surgery for colorectal cancer. Int J Colorectal Dis 11 92–95
DM Hemingway TG Cooke SJ Grime et al. (1991) ArticleTitleChanges in hepatic haemodynamics and the hepatic perfusion index during the growth and development of hypovascular HSN sarcoma in rats. Br J Surg 78 362–370
K Oppo E Leen WJ Angerson TG Cooke CS McArdle (1998) ArticleTitleDoppler perfusion index: Radiology 208 453–457
RC Fowler KM Harris SE Swift M Ward DC Greenwood (1998) ArticleTitleHepatic Doppler perfusion index: Radiology 209 867–871
DM Hemingway G McCurrach RG Bessent JH Mckillop TG Cooke (1991) ArticleTitleDynamic hepatic scintigraphy: Nucl Med Commun 12 811–816
HW Warren H Gallagher DM Hemingway et al. (1998) ArticleTitleProspective assessment of the hepatic perfusion index in patients with colorectal cancer. Br J Surg 85 1708–1712
CG Moertel TR Fleming JS Macdonald DG Haller JA Laurie C Tangen (1993) ArticleTitleAn evaluation of the carcinoembryonic antigen (CEA) test for monitoring patients with resected colon cancer. JAMA 270 943–947
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Glover, C., Douse, P., Kane, P. et al. Accuracy of Investigations for Asymptomatic Colorectal Liver Metastases. Dis Colon Rectum 45, 476–484 (2002). https://doi.org/10.1007/s10350-004-6224-y
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DOI: https://doi.org/10.1007/s10350-004-6224-y