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. 1981 Mar;193(3):357–360. doi: 10.1097/00000658-198103000-00019

Screening for liver metastases from colorectal cancer with carcinoembryonic antigen and alkaline phosphatase.

P I Tartter, G Slater, I Gelernt, A H Aufses Jr
PMCID: PMC1345076  PMID: 7212797

Abstract

A sensitive and economic method of screening for liver metastases in patients with colorectal cancer was developed using serum alkaline phosphatase and carcinoembryonic antigen. The upper limit of normal for alkaline phosphatase and carcinoembryonic antigen did not represent the optimal levels for use in predicting liver metastases. However, with alkaline phosphatase greater than 135 I.U., and/or carcinoembryonic antigen greater than 10 ng/ml, sensitivity was 88%: 23 of 26 patients with liver metastases fulfilled either or both criteria. The false-positive rate was 12%. Liver scanning, alone, demonstrated metastases in only 69% of 35 patients with liver metastases. The combination of alkaline phosphatase and carcinoembryonic antigen can be used economically to screen for liver metastases, and to determine which patients should undergo a liver scan.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ARIEL I. M., SHAHON D. B. Hepatic dysfunction in candidates for abdominal surgery, especially in patients with cancer. Cancer. 1950 Jul;3(4):608–623. doi: 10.1002/1097-0142(1950)3:4<608::aid-cncr2820030406>3.0.co;2-a. [DOI] [PubMed] [Google Scholar]
  2. Baden H., Andersen B., Augustenborg G., Hanel H. K. Diagnostic value of gamma-glutamyl transpeptidase and alkaline phosphatase in liver metastases. Surg Gynecol Obstet. 1971 Nov;133(5):769–773. [PubMed] [Google Scholar]
  3. Castagna J., Benfield J. R., Yamada H., Johnson D. E. The reliability of liver scans and function tests in detecting metastases. Surg Gynecol Obstet. 1972 Mar;134(3):463–466. [PubMed] [Google Scholar]
  4. Conn H. O., Elkington S. G. Is hepatic scanning overated? Gastroenterology. 1968 Jan;54(1):135–140. [PubMed] [Google Scholar]
  5. FENSTER L. F., KLATSKIN G. Manifestations of metastatic tumors of the liver. A study of eighty-one patients subjected to needle biopsy. Am J Med. 1961 Aug;31:238–248. doi: 10.1016/0002-9343(61)90112-7. [DOI] [PubMed] [Google Scholar]
  6. FENSTER L. F., KLATSKIN G. Manifestations of metastatic tumors of the liver. A study of eighty-one patients subjected to needle biopsy. Am J Med. 1961 Aug;31:238–248. doi: 10.1016/0002-9343(61)90112-7. [DOI] [PubMed] [Google Scholar]
  7. GOLD P., FREEDMAN S. O. DEMONSTRATION OF TUMOR-SPECIFIC ANTIGENS IN HUMAN COLONIC CARCINOMATA BY IMMUNOLOGICAL TOLERANCE AND ABSORPTION TECHNIQUES. J Exp Med. 1965 Mar 1;121:439–462. doi: 10.1084/jem.121.3.439. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. GOLLIN F. F., SIMS J. L., CAMERON J. R. LIVER SCANNING AND LIVER FUNCTION TESTS; A COMPARATIVE STUDY. JAMA. 1964 Jan 11;187:111–116. doi: 10.1001/jama.1964.03060150035008. [DOI] [PubMed] [Google Scholar]
  9. Gutierrez R. R., Bacon H. E., Gennaro A. R. The value of liver scan in management of cancer of the large bowel. Dis Colon Rectum. 1968 Jan-Feb;11(1):61–63. doi: 10.1007/BF02616747. [DOI] [PubMed] [Google Scholar]
  10. Gutman A. B., Olson K. B., Gutman E. B., Flood C. A. EFFECT OF DISEASE OF THE LIVER AND BILIARY TRACT UPON THE PHOSPHATASE ACTIVITY OF THE SERUM. J Clin Invest. 1940 Jan;19(1):129–152. doi: 10.1172/JCI101107. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Jhingran S. G., Jordan L., Jahns M. F., Haynie T. P. Liver scintigrams compared with alkaline phosphatase and BSP determinations in the detection of metastatic carcinoma. J Nucl Med. 1971 May;12(5):227–230. [PubMed] [Google Scholar]
  12. Kim U. S., Papatestas A. E., Aufses A. H., Jr Prognostic significance of peripheral lymphocyte counts and carcinoembryonic antigens in colorectal carcinoma. J Surg Oncol. 1976;8(3):257–262. doi: 10.1002/jso.2930080312. [DOI] [PubMed] [Google Scholar]
  13. MENDELSOHN M. L., BODANSKY O. The value of liver-function tests in the diagnosis of intrahepatic metastases in the nonicteric cancer patient. Cancer. 1952 Jan;5(1):1–8. doi: 10.1002/1097-0142(195201)5:1<1::aid-cncr2820050103>3.0.co;2-i. [DOI] [PubMed] [Google Scholar]
  14. McCartney W. H., Hoffer P. B. Carcinoembryonic antigen assay in hepatic metastases detection. An adjunct to liver scanning. JAMA. 1976 Aug 30;236(9):1023–1027. [PubMed] [Google Scholar]
  15. McCartney W. H., Hoffer P. B. Carcinoembryonic antigen assay: an adjunct to liver scanning in hepatic metastases detection. Cancer. 1978 Sep;42(3 Suppl):1457–1462. doi: 10.1002/1097-0142(197809)42:3+<1457::aid-cncr2820420814>3.0.co;2-s. [DOI] [PubMed] [Google Scholar]
  16. Morgenstern S., Kessler G., Auerbach J., Flor R. V., Klein B. An automated p-nitrophenylphosphate serum alkaline phosphatase procedure for the AutoAnalyzer. Clin Chem. 1965 Sep;11(9):876–888. [PubMed] [Google Scholar]
  17. Munjal D., Chawla P. L., Lokich J. J., Zamcheck N. Carcinoembryonic antigen and phosphohexose isomerase, gammaglutamyl transpeptidase and lactate dehydorgenase levels in patients with and without liver metastases. Cancer. 1976 Apr;37(4):1800–1807. doi: 10.1002/1097-0142(197604)37:4<1800::aid-cncr2820370426>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
  18. Read D. R., Hambrick E., Abcarian H., Levine H. The preoperative diagnosis of hepatic metastases in cases of colorectal carcinoma. Dis Colon Rectum. 1977 Mar;20(2):101–106. doi: 10.1007/BF02587324. [DOI] [PubMed] [Google Scholar]
  19. SHAY H., SIPLET H. The value of serum alkaline phosphatase determination and bromsulphalein test in the diagnosis of metastatic cancer of the liver. J Lab Clin Med. 1954 May;43(5):741–751. [PubMed] [Google Scholar]
  20. STIRRETT L. A., YUHL E. T., CASSEN B. Clinical applications of hepatic radioactivity surveys. Am J Gastroenterol. 1954 Apr;21(4):310-5; discussion, 315-7. [PubMed] [Google Scholar]
  21. Sackett D. L. Clinical diagnosis and the clinical laboratory. Clin Invest Med. 1978;1(1):37–43. [PubMed] [Google Scholar]
  22. Sackett D. L. Laboratory screening: a critique. Fed Proc. 1975 Nov;34(12):2157–2161. [PubMed] [Google Scholar]
  23. Sackett D. L. The usefulness of laboratory tests in health-screening programs. Clin Chem. 1973 Apr;19(4):366–372. [PubMed] [Google Scholar]
  24. Schaefer J., Schiff L. Liver function tests in metastatic tumor of the liver: study of 100 cases. Gastroenterology. 1965 Oct;49(4):360–363. [PubMed] [Google Scholar]
  25. Slater G., Papatestas A. E., Aufses A. H., Jr Preoperative carcinoembryonic antigen levels in colorectal carcinoma. Arch Surg. 1979 Jan;114(1):52–53. doi: 10.1001/archsurg.1979.01370250054011. [DOI] [PubMed] [Google Scholar]
  26. Vecchio T. J. Predictive value of a single diagnostic test in unselected populations. N Engl J Med. 1966 May 26;274(21):1171–1173. doi: 10.1056/NEJM196605262742104. [DOI] [PubMed] [Google Scholar]

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