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 colorectal carcinoma.

DESIGN

Prospective, open study.

SETTING

Teaching hospital, Germany.

SUBJECTS

51 Patients with confirmed primary colorectal carcinoma.

INTERVENTIONS

Computed tomography during arterial portography (CT-AP), percutaneous ultrasonography (US), operative palpation and examination of the liver, operative US, and computed tomography (CT) follow-up 6-12 months postoperatively.

MAIN OUTCOME MEASURES

Sensitivity, specificity, positive and negative predictive value, and accuracy.

RESULTS

Overall accuracy was worst for CT during portography, because of the diagnosis of many false positive lesions. Exploration and palpation of the liver had the highest sensitivity (83%) and specificity (100%), and operative US did not give any useful additional information.

CONCLUSIONS

Preoperative percutaneous US is recommended as the best non-invasive screening test; otherwise careful inspection and palpation during operation are sufficient for the evaluation of the liver during primary resection for colorectal carcinoma.