RADIOISOTOPE SCANNING IN PRIMARY CARCINOMA OF THE LIVER.

Abstract

Characteristically, primary hepatic carcinoma remains undetected until advanced. This occultness results primarily from an absence of distinctive clinical features and from the inaccessibility of the liver. Concealment is augmented, in all probability, by a low index of clinical suspicion because of the rarity of the neoplasm in this country. The difficulty in establishing the diagnosis of primary carcinoma of the liver is illustrated by the recent report of Patton and Horn, in which 42 of 60 proved cases remained undiagnosed until autopsy (8). Clinical findings that may be associated with primary hepatic carcinoma include painful hepatomegaly, a palpable hepatic mass, jaundice, and portal hypertension with ascites (frequently sanguineous). The stigmata of cirrhosis, particularly the postnecrotic type, may be present although cirrhosis itself is absent in 25 to 60 per cent of the cases (5). Radiographic findings are nonspecific reflections of hepatomegaly and/or portal hypertension if present (3); however, the demonstration of elevation of the right diaphragm and of esophageal varices should suggest the possibility of primary hepatic carcinoma (10). No distinctive pattern of hepatic functional abnormality has been observed. Since 1954, radioisotope scanning of the liver has provided an atraumatic method for effectively visualizing the liver and mass lesions within it. Its clinical usefulness in detecting and following many forms of hepatic disease has been summarized (2, 11), but its application to the diagnosis of primary hepatic carcinoma has received scant attention in the American literature. Accordingly, it was decided to present the results of radioisotope scanning in primary liver carcinoma at the Columbia-Presbyterian Medical Center. Clinical Material and Methods Thirteen cases of primary hepatic carcinoma were encountered in 1,750 radioisotope scans of the liver obtained since 1960. The diagnosis was established by closed or open liver biopsy (6 cases) or autopsy (7 cases.) The patients ranged in age from five months to seventy-one years ; 10 were male. Postnecrotic cirrhosis was present in 3 cases, and nutritional cirrhosis, periportal fibrosis, and “early cirrhosis” in 1 case each. Radioisotope scanning was performed with a modified conventional scanner containing a collimated 3-in. NaI (Th) crystal and pulse discriminator. The radiopharmaceutical administered to each patient was colloidal gold 198 in intravenous dosage of 2.2 microcuries per kilogram of body weight. Scanning was instituted approximately twenty minutes after injection and was completed forty-five to sixty minutes later. Contrast amplification was utilized in all photoscans. Results The liver was satisfactorily outlined in the 13 patients. Concentration of radioactivity in the extrahepatic reticuloendothelial tissue was increased in 6 patients; this finding was absent in 5 and indeterminate in 2.