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Are liver function tests relevant for early detection of liver metastasis of uveal melanoma?
Author(s) -
MOURIAUX F,
DIORIO C,
BERGERON D,
BERCHI C,
ROUSSEAU A
Publication year - 2011
Publication title -
acta ophthalmologica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.534
H-Index - 87
eISSN - 1755-3768
pISSN - 1755-375X
DOI - 10.1111/j.1755-3768.2011.4268.x
Subject(s) - metastasis , medicine , liver function tests , melanoma , gastroenterology , cancer , pathology , cancer research
Purpose The liver is the main target for screening for uveal melanoma metastasis, which could be achieved by liver function tests (LFTs). The aim of our study is to analyze the relevance of LFTs for detection of metastatic disease in term of prognostic value and cost evaluation Methods Patients (n=88, who developed metastasis while undergoing semi‐annual follow‐up with LFTs including aspartate‐aminotransferase (AST), alanine‐aminotransferase (ALT), gammagutamylransferase (γGT), lactodeshydrogenase (LDH), and phosphatase alkaline (PA) were included. For assessing the level of LFTs for metastasis only the one preceding screening LFTs before the diagnostic by imaging was recorded. Consecutive patients (n=174) with uveal melanoma were chosen as control from patients who did not develop metastasis Results We were able to detect metastasis after LFTs abnormality in 40 (45%) patients. However, at the time of the one preceding screening LFTs before the metastasis diagnosis, 51(58%) patients had at least one abnormal LFT. The metastasis diagnosis was missed in 11 patients (13%). The overall sensitivity of LFTs ranged from 12.5 to 58.0% and the predictive positive value ranged from 9.4 to 38.6%. Interestingly we observed false positives in 20.3% with the variable “at least one abnormal LFT”. Using financial approach, we calculated the semi‐annual screening by LFTs. Conclusion Using the most important retrospective series analyzing semi‐annually all LFTs, we demonstrate that LFTs screening (AST, ALT, γGT, LDH and PA) is not relevant for detection of early metastasis even if the over cost induced by imaging requested for false positive is low