The detection of occult liver metastases of colorectal carcinoma

Abstract

Despite undergoing an apparently curative surgery, over 50% of colorectal cancer patients will die within 5 years, the majority within the first 2 years from disseminated disease. Occult liver metastases are reported to be present in approximately 30% of patients and they predominantly determine the likelihood of dying from disseminated disease. The question is how to detect these occult hepatic metastases. This article reviews some of the alternative techniques, such as dynamic scintigraphy, functional computerized tomography, and duplex colour Doppler sonography (DCDS), which have been developed to predict which patients harbor these occult metastases. More recently, DCDS measurements of the Doppler perfusion index (DPI: ratio of hepatic arterial to total liver blood flow) have been shown to be highly accurate in the detection of these occult liver metastases. In addition, irrespective of Dukes stage, patients with abnormal DPI were shown to have a very poor outcome while for those with normal DPI, the prognosis was excellent. If the data are reproduced, the administration of adjuvant chemotherapy should be based on DPI status rather than Dukes stage.

Whole‐liver CT texture analysis in colorectal cancer: Does the presence of liver metastases affect the texture of the remaining liver?

“…[1][2][3][4] Studies have reported that >20% of CRC patients present with synchronous metastasis at primary staging. 5 Furthermore, cumulative rates of metachronous liver metastases of 4.3% have been reported at one-year follow-up, increasing up to 14.5% at five-year follow-up.…”

“…3 It has been hypothesised that these metachronous liver metastases may in fact develop from occult liver metastases that are already present at the time of primary staging. 4,6 The presence of occult liver metastases (as established at histopathological examination after liver surgery) is associated with an unfavourable prognostic outcome regarding overall survival, 7 and addition of chemotherapy may reduce the presence of micrometastases. 8 With conventional staging tools it has so far not been feasible to establish the presence of micrometastases within the liver.…”

Biodistribution of the radiopharmaceutical sodium pertechnetate after biliopancreatic bypass with a duodenal switch

“…(Adachi et al, 1999), as well as anastomoses patency (Blachar, 2004). Diagnosis of cancer metastasis (Leen., 1999), and postoperative chances in kidney, liver, lung, heart and other organs are done using scintigraphy with radiotracers and pertechnetate (Aktas et al, 2005;Chalela, 1999). In the present work the DS did not affect the biodistribution of sodium pertechnetate in liver, stomach, small bowel, duodenum, kidney, heart, bladder, bone and brain.…”

Preoperative granulocyte/macrophage colony-stimulating factor (GM-CSF) increases hepatic dendritic cell numbers and clustering with lymphocytes in colorectal cancer patients

“…Postsurgical development of liver metastases can be influenced by several factors. First, occult (micro) metastases might have been present at the time of surgery (Leen, 1999). Second, perioperative presence of cancer cells in the portal circulation has been detected (Sales et al, 1999).…”