A prospective study of the ability of laboratory tests to detect or to exclude hepatic metastases was performed. Seventy-four patients who underwent liver biopsies were divided into 3 groups: 1) 33 patients with secondary liver involvement from adenocarcinoma; 2) 21 subjects suffering from a non-malignant hepatic disease, and 3) 20 cancerous patients free of overt hepatic metastases. They were investigated with 7 laboratory tests. No single test had a positive predictive value higher than 75%. This percentage was increased to 84% by combining the results of both CEA and rapidly migrating liver alkaline phosphatase isoenzyme ALP 1. More important was the fact that when those parameters were both normal, the negative predictive value was 93%, thus tending to exclude a liver metastatic involvement with an acceptable confidence limit.
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