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JJ Pe'er, I Kaiserman, R Amer; Efficacy of Liver Function Tests in Detecting Liver Metastasis from Uveal Melanoma . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1141.
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Purpose: To evaluate the sensitivity, specificity and predictive value of liver function tests in detecting liver metastasis from uveal melanoma. Methods: Of 307 uveal melanoma patients (mean age 60 years, range 29 - 92 years) who were diagnosed with uveal melanoma in our department between the years 1988 and 1998, 53 developed liver metastasis (mean age 59 years, range 29 - 84 years). We studied 33 patients who regularly (on average every 6 months) underwent liver function tests and liver imaging, while excluding 20 patients due to insufficient follow-up or having metastasis present at the first examination. Of the 254 patients who did not develop metastasis, 80 were randomly chosen as controls. All medical records of the metastatic group and the control group were reviewed, and the liver function tests and liver imaging results were documented. The efficacy of liver function tests for detecting metastasis was evaluated in comparison to detection of metastasis by liver imaging. Results: Looking at the diagnostic value of liver function tests, in our study an abnormal test (at least one abnormal enzyme) had a diagnostic sensitivity of 15%, specificity of 84% and positive predictive value of 25%. While no change was noted in the mean serum levels of bilirubin pre- and post-detection of metastasis, the mean AST and ALT levels were elevated 6 months after the detection. In contrast, alkaline-phosphatase and GTP seemed to rise an average of 6 months prior to the detection of metastasis, even though they may remain within the normal limits. Conclusion: The sensitivity and predictive value of abnormal liver function tests in diagnosing uveal melanoma metastases are extremely low and unreliable. However, alkaline-phosphatase and GTP do tend to rise prior to detection of metastasis by imaging, indicating that their trend, even though within normal limits, should be routinely monitored in patients with uveal melanoma.
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