Liver Function Tests and Needle Biopsy in the Diagnosis of Metastatic Cancer of the Liver

Abstract

A standard battery of liver function tests was performed in a group of 159 patients with cancer, half of whom were shown shortly thereafter to have hepatic metastases at autopsy. Although the mean levels of alkaline phosphatase (AP), glutamic-oxalacetic transaminase (SGOT), bromsulphalein (BSP) and total bilirubin were significantly higher in the patients with hepatic involvement than in those without, and although the degree of abnormality of these tests paralleled the extent of metastatic involvement, these tests were frequently abnormal in patients without hepatic metastases and normal in patients with hepatic invasion. Simultaneous abnormalities of two or more of the SGOT, AP and BSP were more accurate indices of hepatic metastases. A single postmortem needle aspiration of the liver demonstrated hepatic metastases in almost half of all the patients with abnormal AP, SGOT or bilirubin levels, in about one-third of those with increased BSP retention, and in almost two-thirds of those with multiple abnormalities of these tests. A second needle aspiration increased the incidence of detected metastases to 589c [center dot] Even in patients with completely normal liver function tests, liver biopsy was positive in from 20 to 35% of patients with hepatic metastases, and in about 109c of all the cancer patients with normal liver function tests. Abnormal liver function tests are helpful indices of metastatic involvement of the liver and serve to predict that liver biopsy will detect metastases in a relatively high percentage of patients with such abnormalities. Even in the absence of abnormal liver functions tests liver biopsy may be advantageously used to exclude hepatic metastases prior to major surgical procedures in patients with cancer.