<p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p> <p>Carcinoembryonic antigen and some liver function tests (alkaline phosphatase, gamma-glutamyl-transpeptidase,
lactic dehydrogenase and cholinesterase) were evaluated in patients with primary
colorectal cancer in order to define their role in the pre-operative detection of liver metastases.</p> <p>The records of 278 consecutive patients admitted to the Istituto Nazionale Tumori of Milan between
January 1982 and December 1983 who were suffering from primary invasive colo-rectal cancer and who
underwent laparotomy were retrospectively analyzed.</p> <p>At laparotomy, liver metastases were found in 38 pts (13.7%). Considering single tests, CEA was the
most sensitive (71%); no single test was found to be reliably predictive, when the result was abnormal.
On the contrary, the normal value of each test was associated with a good prediction.</p> <p>When we considered all the five tests together in the single patient their predictive value, when
abnormal, proved to be quite good only if four or five results were abnormal. On the other hand, liver
metastases in the presence of all normal tests were found only in two patients, so giving a negative
predictive value of about 97%.</p> <p>So we conclude that, in the lack of an infallable imaging technique for liver evaluation, in the presence
of all normal tests any other investigation on the liver could be avoided. However, when liver tests are
pathologic, some other imaging technique should be performed in order to supply the surgeon with
information about the extent and the spread of the metastases.</p>
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HPB Surg. 1990; 3(1):29-37