title: Liver function tests: inadequate screening modality for detection of liver metastasis in head and neck carcinoma.
abstract: OBJECTIVE
  Report the prevalence and risk factors of liver metastasis in head and neck squamous cell carcinoma (HNSCC) while evaluating the utility of liver function tests (LFTs) in detection of such metastases.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  Tertiary referral center.
  
  
  METHODS
  Of 745 patients with newly diagnosed HNSCC (oral cavity, oropharynx, hypopharynx, larynx) treated at University of North Carolina hospitals from 1989 to 2005, 655 had sufficient data for analysis.
  
  
  RESULTS
  Prevalence of liver metastasis was 3% (20/655) with 7 patients demonstrating early metastasis and 12 with late metastasis. Oropharyngeal and hypopharyngeal lesions constituted 65% of identified liver metastasis but only 39% of the study population. Patients with oropharyngeal lesions were most likely to develop liver metastasis (P = .047). Abnormal LFTs were seen in 26% of all patients. Overall sensitivity and specificity were 45% and 75%. Seventy-five percent of patients with liver metastasis had stage IV disease at diagnosis and were more likely to have abnormal LFTs than other stages (P = .048). In these patients, 2.2% (8/365) had liver metastases and abnormal LFTs, whereas 1.9% (7/365) had liver metastases and normal LFTs. Sensitivity for alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and lactate dehydrogenase 0%, 10%, 20%, and 30%, respectively. Specificities ranged from 88.0% to 94.3%. Positive predictive values were poor, with the highest being 10.5%.
  
  
  CONCLUSIONS
  Liver metastases are rare in HNSCC and often delayed in presentation. This study clearly reveals that LFTs do not reliably identify patients with liver metastasis and do not provide physicians with an adequate screening modality in this population.
authors: Lineberger Comprehensive Cancer Center Biostatistics Core, University of North Carolina, Chapel Hill, North Carolina, USA.
authors: Allison M
authors: AM
authors: Deal
authors: Mihir R
authors: MR
authors: Patel
authors: Brian D
authors: BD
authors: Thorp
authors: Trinitia Y
authors: TY
authors: Cannon
authors: Carol G
authors: CG
authors: Shores
authors: Adam M
authors: AM
authors: Zanation
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000453:epidemiology* / Q000556:secondary; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000556:secondary; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000378:metabolism / Q000556:secondary; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000077195:Squamous Cell Carcinoma of Head and Neck; D015996:Survival Rate / Q000639:trends; D055815:Young Adult