DETECTION OF OCCULT LIVER METASTASES BY MEASUREMENT OF BILIARY CARCINOEMBRYONIC ANTIGEN CONCENTRATIONS

Objective: To assess whether biliary CEA concentrations can be used as early markers of occult liver metastases in patients with colorectal cancer. Design: Consecutive open study. Setting: University hospital, The Netherlands. Subjects: 76 patients with a primary colorectal carci noma (group 1) and 19 patients who had recently undergone a curative r esection of a locally advanced carcinoma (group 2). Interventions: Bil e sampling by transhepatic puncture of the gallbladder. Main outcome m easure: Recurrence of tumour. Results: Twenty-one of the 76 patients ( 28%) with primary colorectal carcinoma had liver metastases; all had a raised biliary CEA concentration. Of the remaining 55 patients 39 (71 %) also had raised CEA concentrations. At a median follow-up of 30 mon ths, only seven patients had developed liver metastases, indicating a high number of false-positive results. In Group 2 7/19 patients (37%) had a CEA concentration above the cut-off point. Six of them developed recurrent tumour; 2 patients had liver metastases and 4 others had ex trahepatic recurrences. None of the 12 patients with biliary CEA conce ntrations within the reference range has developed recurrent tumour. C onclusion: Biliary CEA concentrations do not predict the presence. of occult liver metastases if bile samples are taken during resection of the primary tumour. If samples are taken some time afterwards, a raise d CEA concentration seems to predict recurrence at an early stage, eit her in or outside the liver.