Detection of occult liver metastases by measurement of biliary carcinoembryonic antigen concentrations.

Objective: To assess whether biliary CEA concentrations can be used as early markers of occult liver metastases in patients with colorectal cancer.

Design: Consecutive open study.

Setting: University hospital, The Netherlands.

Subjects: 76 patients with a primary colorectal carcinoma (group 1) and 19 patients who had recently undergone a curative resection of a locally advanced carcinoma (group 2).

Interventions: Bile sampling by transhepatic puncture of the gallbladder.

Main Outcome Measure: Recurrence of tumour.

Results: Twenty-one of the 76 patients (28%) with primary colorectal carcinoma had liver metastases; all had a raised biliary CEA concentration. Of the remaining 55 patients 39 (71%) also had raised CEA concentrations. At a median follow-up of 30 months, only seven patients had developed liver metastases, indicating a high number of false-positive results. In Group 2 7/19 patients (37%) had a CEA concentration above the cut-off point. Six of them developed recurrent tumour; 2 patients had liver metastases and 4 others had extrahepatic recurrences. None of the 12 patients with biliary CEA concentrations within the reference range has developed recurrent tumour.

Conclusion: Biliary CEA concentrations do not predict the presence of occult liver metastases if bile samples are taken during resection of the primary tumour. If samples are taken some time afterwards, a raised CEA concentration seems to predict recurrence at an early stage, either in or outside the liver.