ETIOLOGIC DIAGNOSIS OF HEPATIC-LESIONS IN CANCER-PATIENTS - VALUE OF ULTRASOUND AND LIVER-FUNCTION TESTS

The purpose of this study was to evaluate the value of a combination o f ultrasound (US) and liver function tests (LFT) for determination of the benign or malignant nature of one or more haptic lesions in cancer patients. A total of 1235 patients with hepatic metastases and 832 pa tients with benign liver lesions investigated by US-LFT over a 12-year period were analyzed retrospectively. Ultrasound patterns considered indicative of benign process (cyst, calcification without mass, irregu lar hyperechoic area without mass effect, small hyperechoic focal lesi on as less than 3 cm) or malignancy (peritumoral halo, hypoechoic foca l lesion, multiple solid nodules) were associated with LFT results. A US pattern of a benign process associated with normal LFT led to a dia gnosis of benign disease with a false negative rate for malignancy of 11.6%. The highest figure corresponded to small hyperechoic nodules, f or which the positive predictive value of malignancy (PPVM) depended o n the type of primary cancer: 2.1% for breast cancer versus 62.5% for colorectal cancer. A US criterion of malignancy associated with abnorm al LFT led to a diagnosis of malignancy (PPV 96.2% to 100%). Overall, the combination of US and LFT had a sensitivity of 80.6% and a specifi city of 99.4%. The US-LFT combination correctly determined the benign or malignant nature of 74.5% of all hepatic lesions; the PPV was never less than 96.2% (small and solitary hyperechoic focal lesions were ex cluded because their PPV for malignancy is too high). (C) Published by Elsevier Science Inc., 1997.