LIVER SCANNING IN PATIENTS WITH COLORECTAL CARCINOMA

Abstract

Three hundred liver scans were performed on a routine basis in patients with colorectal carcinoma, before and after operation, to detect hepatic metastases. In 98 of 106 pre-operative and 28 of 194 postoperative scans, confirmation of the pathological condition was obtained at operation or post-mortem examination. The overall diagnostic accuracy of the scan was 77.4%, but the false-positive rate was high. The presence of focal defects in liver scans before operation did not influence our decision regarding abdominal exploration. After operation on patients who did not have disseminated disease and whose liver scans showed localized focal defects, selective hepatic arteriography and abdominal exploration did not reveal resectable metastatic disease. In one-third of patients with abnormal liver scans after operation, subsequent scans returned to normal. Of the patients with true positive liver scans, three-quarters had clinically evident hepatic metastases. Serum alkaline phosphatase estimations were as accurate in detecting liver metastases as the liver scan, and returned fewer false-positive results. Routine liver scanning before or after operation is not recommended for patients with colorectal carcinoma and should be reserved for patients with clinical features or biochemical abnormalities suggestive of liver metastases.