PROSPECTIVE EVALUATION OF DIFFERENT DIAGNOSTIC-TECHNIQUES FOR THE DETECTION OF LIVER METASTASES AT THE TIME OF PRIMARY RESECTION OF COLORECTAL-CARCINOMA

Objective: To evaluate preoperative and operative methods of detecting liver metastases in patients undergoing primary resection for colorec tal carcinoma. Design: Prospective, open study. Setting: Teaching hosp ital, Germany. Subjects: 51 Patients with confirmed primary colorectal carcinoma. Interventions: Computed tomography during arterial portogr aphy (CT-AP), percutaneous ultrasonography (US), operative palpation a nd examination of the liver, operative US, and computed tomography (CT ) follow-up 6-12 months postoperatively. Main outcome measures: Sensit ivity, specificity, positive and negative predictive value, and accura cy. Results: Overall accuracy was worst for CT during portography, bec ause of the diagnosis of many false positive lesions. Exploration and palpation of the liver had the highest sensitivity (83%) and specifici ty (100%), and operative US did not give any useful additional informa tion. Conclusions: Preoperative percutaneous US is recommended as the best non-invasive screening test; otherwise careful inspection and pal pation during operation are sufficient for the evaluation of the liver during primary resection for colorectal carcinoma.