Liver function testing is not helpful for early diagnosis of metastatic uveal melanoma.
OBJECTIVE
To study the relevance of liver function test (LFT) results for early detection of liver metastasis of uveal melanoma.


METHODS
Evaluation of diagnostic test.


METHODS
Eighty-eight patients were included in whom metastasis developed while undergoing semiannual follow-up with LFTs, including aspartate-aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyltransferase (γGT), lactate dehydrogenase (LDH), and phosphatase alkaline (PA). As controls, 174 patients with uveal melanoma without metastasis were included.


METHODS
The diagnostic attributes of sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for each test were estimated from cross-tabulation tables of test results according to the diagnosis of metastasis. The proportions of false-positive results between groups of patients with and without metastasis were compared in log-binomial regression models.


METHODS
Sensitivity, specificity, PPV, NPV, and cost evaluation.


RESULTS
Metastases were detected after LFT abnormality (at least 1 abnormal test result) in 40 (45%) patients. The overall sensitivity of LFTs ranged from 12.5% to 58.0%, and the PPV ranged from 9.4% to 38.6%. The overall specificity and NPV were 90% or greater. The proportions of false-positive results between groups of patients with and without metastasis did not differ significantly (all P≥0.38). Using a cost evaluation, semi-annual screening by LFTs was calculated to cost $35.5/year per patient, including liver imaging induced by true and false-positive results.


CONCLUSIONS
Isolated or combined LFTs for AST, ALT, γGT, LDH, and PA are not helpful for detection of early metastasis. However, the high NPVs suggest that LFT screening can allow clinicians to reassure the patient when the LFT results are negative.
Centre Universitaire d'Ophtalmologie, Hôpital du St Sacrement, CHA, Québec, Canada. mouriaux-f@chucaen.fr
Frédéric
F
Mouriaux
Caroline
C
Diorio
Dan
D
Bergeron
Célia
C
Berchi
Alain
A
Rousseau
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000410:Alanine Transaminase / Q000097:blood; D000469:Alkaline Phosphatase / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D015415:Biomarkers / Q000097:blood; D055088:Early Detection of Cancer; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008111:Liver Function Tests / Q000191:economics; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000201:enzymology / Q000556:secondary; D008297:Male; D008545:Melanoma / Q000175:diagnosis* / Q000201:enzymology / Q000556:secondary; D008875:Middle Aged; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D014604:Uveal Neoplasms / Q000473:pathology*; D055815:Young Adult; D005723:gamma-Glutamyltransferase / Q000097:blood
D015415:Biomarkers; D007770:L-Lactate Dehydrogenase; D005723:gamma-Glutamyltransferase; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase; D000469:Alkaline Phosphatase