A retrospective study was conducted to determine the sensitivity, specificity, and accuracy of scintigraphy, ultrasound, and CT scanning in conjunction with biochemical tests in the detection of liver neoplasia. Sixty-three patients with metastatic liver disease and 45 patients with nonmalignant liver disease received a total of 46 liver/spleen scan, 61 ultrasounds, and 49 CT scans. The sensitivities of liver/spleen scan, ultrasound, and CT scan were 72, 73, and 81%, respectively; the specificities were 86, 94, and 83%, respectively; and, the accuracies were 78, 84, and 82%, respectively. No statistically significant difference in specificity, sensitivity, or accuracy was seen between the three imaging studies. The serum alkaline phosphatase was significantly more accurate than total bilirubin and SGOT in detecting liver metastasis. However, 19 and 13% of the malignant and nonmalignant groups, respectively, had normal biochemical tests. The sensitivity, specificity, and accuracy of the imaging studies in the presence of an abnormal alkaline phosphatase, SGOT, or total bilirubin were not significantly different than in the presence of normal biochemical tests. These results suggest that other factors such as cost, reproducibility, and availability of skilled interpreters should be considered in the selection of imaging studies for the detection of neoplastic liver disease.
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