Kamby C, Dirksen H, Vejborg I, Daugaard S, Guldhammer B, Rossing N, Mouridsen H T
Cancer. 1987 Apr 15;59(8):1524-9. doi: 10.1002/1097-0142(19870415)59:8<1524::aid-cncr2820590823>3.0.co;2-9.
The occurrence of liver metastases was evaluated by ultrasonic scanning and correlated with prognostic factors, pattern of metastases, clinical examination, biochemical liver function tests from serum, and liver biopsy specimens in 394 consecutive evaluable patients with first recurrence of breast cancer. Fifty-nine patients (15%) had a positive scan, and liver metastases were the only sign of recurrent disease in 11 of these patients. The presence of liver metastases was not associated with age, menopausal status, size of the primary tumor, regional lymph node status, or the length of the recurrence-free interval; but patients with liver metastases were significantly closer to the menopause than those without (P = 0.02). The diagnostic value of clinical examinations was comparable to that of serum bilirubin and serum aspartate aminotransferase (ASAT) analyses, but was significantly better than alkaline phosphatase (AP) and lactate dehydrogenase (LDH) analyses. Analysis of serum AP was not a valuable diagnostic tool in the diagnosis of liver metastases, since it was elevated in 58% of the patients with bone metastases, and since metastases in this site were found in one third of the patients without liver metastases. If all four tests were negative, liver metastases were excluded in 99% of the patients, and if more than two of the four tests were positive, liver metastases were found in 95%. Valid (greater than 80%) diagnosis of liver metastases by serum LDH or serum ASAT alone, required an elevation of three or five times the upper normal limits, respectively. Thirty-nine patients with positive ultrasonography results underwent biopsy. The ultrasonographic diagnosis could not be confirmed histologically in three patients (8%). If ultrasonic scanning had not been performed routinely, only one of 213 patients (0.5%) with soft tissue metastases would have been offered local therapy rather than systemic treatment. These data suggest that ultrasonic scanning of the liver should not be a routine diagnostic tool in examination of patients with first recurrence of breast cancer. However, whenever indicated by clinical signs or elevated blood tests, scanning should be performed to confirm the presence of liver metastases, particularly in patients entering therapeutical trials, since liver metastases demonstrated by ultrasound examinations may serve as a measurable parameter.
对394例首次复发的乳腺癌连续可评估患者，通过超声扫描评估肝转移的发生情况，并将其与预后因素、转移模式、临床检查、血清生化肝功能试验及肝活检标本进行关联分析。59例患者（15%）扫描结果为阳性，其中11例患者肝转移是复发疾病的唯一征象。肝转移的存在与年龄、绝经状态、原发肿瘤大小、区域淋巴结状态或无复发生存期长短无关；但有肝转移的患者比无肝转移的患者更接近绝经期（P = 0.02）。临床检查的诊断价值与血清胆红素和血清天冬氨酸转氨酶（ASAT）分析相当，但明显优于碱性磷酸酶（AP）和乳酸脱氢酶（LDH）分析。血清AP分析在肝转移诊断中不是一个有价值的诊断工具，因为58%有骨转移的患者其AP升高，且在三分之一无肝转移的患者中也发现了该部位的转移。如果所有四项检查均为阴性，则99%的患者可排除肝转移；如果四项检查中有两项以上为阳性，则95%的患者可发现肝转移。单独通过血清LDH或血清ASAT有效（大于80%）诊断肝转移，分别需要升高至正常上限的三倍或五倍。39例超声检查结果阳性的患者接受了活检。3例患者（8%）的超声诊断未能得到组织学证实。如果未常规进行超声扫描，213例有软组织转移的患者中只有1例（0.5%）会接受局部治疗而非全身治疗。这些数据表明，在首次复发的乳腺癌患者检查中，肝脏超声扫描不应作为常规诊断工具。然而，每当有临床体征或血液检查结果升高提示时，应进行扫描以确认肝转移的存在，特别是在进入治疗试验的患者中，因为超声检查显示的肝转移可作为一个可测量的参数。
