title: Detection of occult liver metastases by measurement of biliary carcinoembryonic antigen concentrations.
abstract: OBJECTIVE
  To assess whether biliary CEA concentrations can be used as early markers of occult liver metastases in patients with colorectal cancer.
  
  
  METHODS
  Consecutive open study.
  
  
  METHODS
  University hospital, The Netherlands.
  
  
  METHODS
  76 patients with a primary colorectal carcinoma (group 1) and 19 patients who had recently undergone a curative resection of a locally advanced carcinoma (group 2).
  
  
  METHODS
  Bile sampling by transhepatic puncture of the gallbladder.
  
  
  METHODS
  Recurrence of tumour.
  
  
  RESULTS
  Twenty-one of the 76 patients (28%) with primary colorectal carcinoma had liver metastases; all had a raised biliary CEA concentration. Of the remaining 55 patients 39 (71%) also had raised CEA concentrations. At a median follow-up of 30 months, only seven patients had developed liver metastases, indicating a high number of false-positive results. In Group 2 7/19 patients (37%) had a CEA concentration above the cut-off point. Six of them developed recurrent tumour; 2 patients had liver metastases and 4 others had extrahepatic recurrences. None of the 12 patients with biliary CEA concentrations within the reference range has developed recurrent tumour.
  
  
  CONCLUSIONS
  Biliary CEA concentrations do not predict the presence of occult liver metastases if bile samples are taken during resection of the primary tumour. If samples are taken some time afterwards, a raised CEA concentration seems to predict recurrence at an early stage, either in or outside the liver.
authors.affiliation: Department of Surgery, Free University Hospital, Amsterdam, The Netherlands.
authors.forename: M A
authors.initials: MA
authors.lastname: Paul
authors.forename: J J
authors.initials: JJ
authors.lastname: Visser
authors.forename: C
authors.initials: C
authors.lastname: Mulder
authors.forename: J G
authors.initials: JG
authors.lastname: Blomjous
authors.forename: G J
authors.initials: GJ
authors.lastname: van Kamp
authors.forename: M A
authors.initials: MA
authors.lastname: Cuesta
authors.forename: S
authors.initials: S
authors.lastname: Meijer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001646:Bile / Q000737:chemistry*; D002272:Carcinoembryonic Antigen / Q000032:analysis*; D015179:Colorectal Neoplasms / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local
chemical_list: D002272:Carcinoembryonic Antigen