DETECTION OF HEPATIC METASTASES IN COLORECTAL-CANCER - A PROSPECTIVE-STUDY OF LABORATORY AND IMAGING METHODS

Objective: To assess and compare the accuracy of imaging methods (ultr asonography (US), computed tomography (CT), angiography, arterially en hanced CT with computed tomographic arterial portography (CTA)), bioch emical analyses, and surgical assessment during the operation, in dete cting the presence or absence of hepatic metastases in patients with c olorectal cancer. Design: Open study. Setting: University of Lund, Swe den. Subjects: 71 consecutive patients without clinical evidence of li ver metastases at the time of the operation for removal of the primary tumour. Interventions: Regular biochemical tests for five to seven ye ars, and CT and US one year after operation in all patients without co nfirmed metastases. Main outcome measures: Presence or absence of hepa tic metastases. Results: Accuracy of surgical assessment, angiography, US, CT and CTA was 90, 77, 80, 82 and 83%, respectively, and correspo nding predictive values of a negative test were 87, 75, 77, 80 and 84% . Measurement of bilirubin concentration and hepatic enzyme activities were not helpful, and that of carcinoembryonic antigen had an accurac y of only 70%. Accuracy and predictive values were not improved by com bining tests. Conclusion: The accuracy of US, CT or CTA was not good e nough to merit routine use before operations for colorectal cancer. Th ey are potentially valuable for monitoring progress at follow up, but this remains to be confirmed.