title: Screening for metastasis from choroidal melanoma: the Collaborative Ocular Melanoma Study Group Report 23.
abstract: OBJECTIVE
  To describe the predictive value of liver function tests (LFTs), chest x-ray, and diagnostic imaging for detecting melanoma metastasis during routine follow-up after treatment for choroidal melanoma.
  
  
  METHODS
  Prospective longitudinal follow-up of patients enrolled onto two randomized trials was conducted by the Collaborative Ocular Melanoma Study (COMS) Group. Baseline and annual or semiannual systemic and laboratory evaluations were performed according to a standard protocol for 2320 patients enrolled on the COMS.
  
  
  RESULTS
  COMS patients were screened annually for metastasis and new cancers using LFTs (alkaline phosphatase, AST, ALT, or bilirubin). Elevated findings (1.5 to 2 times upper limit of normal) on LFT prompted a diagnostic or imaging test to confirm or rule out cancer recurrence. Of 714 patients with clinical reports of metastasis, 675 patients died. Of these 675 patients, all but four had either histopathologically confirmed or clinically suspected metastatic melanoma present at the time of death. Among all patients, the 5-year cumulative diagnosis rate of metastatic melanoma was 24% (95% CI, 22% to 27%). Based on all patients with reported metastasis, the sensitivity, specificity, positive predictive value and negative predictive value associated with at least one abnormal LFT before first diagnosis of metastasis at any site was 14.7%, 92.3%, 45.7% and 71.0%, respectively.
  
  
  CONCLUSIONS
  Use of LFTs results followed by diagnostic tests has high specificity and predictive values but low sensitivity. Better tests are needed to identify earlier metastatic disease associated with choroidal melanoma.
authors.affiliation: The Wilmer Ophthalmologial Institute, Johns Hopkins University, Baltimore, MD 21205, USA. mdiener@jhsph.edu
authors.forename: Marie
authors.initials: M
authors.lastname: Diener-West
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Reynolds
authors.forename: Donna J
authors.initials: DJ
authors.lastname: Agugliaro
authors.forename: Robert
authors.initials: R
authors.lastname: Caldwell
authors.forename: Kristi
authors.initials: K
authors.lastname: Cumming
authors.forename: John D
authors.initials: JD
authors.lastname: Earle
authors.forename: Donna L
authors.initials: DL
authors.lastname: Green
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Hawkins
authors.forename: James
authors.initials: J
authors.lastname: Hayman
authors.forename: Ishmael
authors.initials: I
authors.lastname: Jaiyesimi
authors.forename: John M
authors.initials: JM
authors.lastname: Kirkwood
authors.forename: Wui-Jin
authors.initials: WJ
authors.lastname: Koh
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Robertson
authors.forename: John M
authors.initials: JM
authors.lastname: Shaw
authors.forename: Jonni
authors.initials: J
authors.lastname: Thoma
mesh_terms: D000469:Alkaline Phosphatase / Q000097:blood; D002830:Choroid Neoplasms / Q000473:pathology*; D005500:Follow-Up Studies; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000175:diagnosis / Q000556:secondary; D008545:Melanoma / Q000473:pathology*; D012680:Sensitivity and Specificity
chemical_list: D000469:Alkaline Phosphatase