The diagnosis of the liver metastasis in gastric cancer

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It is important for a surgeon to ascertain whether or not the liver is free from involvement of metastases prior to an operation as this frequently influences the decision on therapy.Then, selective angiography by Seldinger's procedure; radioactive isotope liver scan, and measurement of α-fetoprotein (AFP) were performed on 94 patients with gastric cancer.In order to determine the relative value of these examinations, the accuracy of liver scan, angiography and value of AFP were compared with laparotomy, autopsyfindings and microangiogram of the liver. Each patient was scheduled to receive intravenously either 198Au-colloidal gold or 99mTc colloid and selective celiac angiography 13 x-ray films were taken in 19 seconds by the Seldinger's techinique. Ouchterlony's method or radioimmunoassay method was used to measure AFP. The liver scan was performed 91 out of 94 patients; selective angiography -73 (77.6%); and measurement of AFP-74 (78.6%).Of 94 cases of gastric cancer, 5 were early cancer, 89 were advanced. Metastases to liver were found out in 26 cases (28%), consist of autopsy (2 cases), laparotomy (18 cases) and clinical findings (6 cases).All of liver scans were subsequently divided into six categories. 1) standard type, 2) atrophic type, 3) hypertrophic type, 4) scirrhotic type, 5) simple deficient type, 6) multiple deficient type. Of a total of 91 scans, consists of 39 standard type, 31 deficient type which includes the 13 false positive scans: 70 cases (77%) were correctly diagnosed by liver scan and 20 cases (23%) were proved to be positive and false negative scans. There were 8 false negative cases of which metastatic lesions were less than 2cm in diameter.The angiographic findings were subsequently analyzed. The only 6 positive cases were identified by direct sign of tumor neovascularization, and indirect signs such as stretching of the vessels due to hepatic infiltration and enlargement, vascular displacement by growing tumor masses.
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The diagnosis of the liver metastasis in gastric cancer

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