title: The value of clinical assessment for preoperative prediction of liver metastases in suspected gastrointestinal cancer. A prospective, consecutive study.
abstract: Surgeons' ability to predict liver metastases preoperatively was studied in 185 operable, nonicteric patients strongly suspected to have gastrointestinal cancer. The prediction was based on a clinical assessment comprising medical history, physical examination and low-cost laboratory tests. A pathoanatomic verification procedure was used. The observed predictive value of a positive test was 0.67 and there was a false-negative ratio of 0.79. At the clinical assessment, presence of metastases was believed to be more common in gastric than in colorectal disease (6/43 vs. 3/142), but the actual incidence of metastases was similar in the two groups. Serum alkaline phosphatase (AP) was a priori believed to be of value in the clinical assessment. But the clinical assessment with inclusion of AP was inferior to AP alone as a predictor of metastases, due to undervaluation of the importance of elevated AP in cases of colorectal disease. The difficulties in standardization of the clinical assessment are underlined.
mesh_terms: D000328:Adult; D000368:Aged; D000469:Alkaline Phosphatase / Q000097:blood; D004796:Clinical Enzyme Tests; D005770:Gastrointestinal Neoplasms / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary*; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000469:Alkaline Phosphatase