Liver function tests: inadequate screening modality for detection of liver metastasis in head and neck carcinoma

• Published in: Otolaryngology-head and neck surgery Vol. 146; no. 1; p. 88
• Main Authors: Deal, Allison M, Patel, Mihir R, Thorp, Brian D, Cannon, Trinitia Y, Shores, Carol G, Zanation, Adam M
• Format: Journal Article
• Language: English
• Published: England 01.01.2012
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - epidemiology; Carcinoma, Squamous Cell - secondary; Child; Child, Preschool; Female; Follow-Up Studies; Head and Neck Neoplasms - diagnosis; Head and Neck Neoplasms - epidemiology; Head and Neck Neoplasms - secondary; Humans; Liver Function Tests; Liver Neoplasms - epidemiology; Liver Neoplasms - metabolism; Liver Neoplasms - secondary; Male; Mass Screening - methods; Middle Aged; North Carolina - epidemiology; Prevalence; Prognosis; Reproducibility of Results; Retrospective Studies; Sensitivity and Specificity; Squamous Cell Carcinoma of Head and Neck; Survival Rate - trends; Young Adult; North Carolina
• ISSN: 1097-6817
• DOI: 10.1177/0194599811425147

Report the prevalence and risk factors of liver metastasis in head and neck squamous cell carcinoma (HNSCC) while evaluating the utility of liver function tests (LFTs) in detection of such metastases. Case series with chart review. Tertiary referral center. Of 745 patients with newly diagnosed HNSCC (oral cavity, oropharynx, hypopharynx, larynx) treated at University of North Carolina hospitals from 1989 to 2005, 655 had sufficient data for analysis. Prevalence of liver metastasis was 3% (20/655) with 7 patients demonstrating early metastasis and 12 with late metastasis. Oropharyngeal and hypopharyngeal lesions constituted 65% of identified liver metastasis but only 39% of the study population. Patients with oropharyngeal lesions were most likely to develop liver metastasis (P = .047). Abnormal LFTs were seen in 26% of all patients. Overall sensitivity and specificity were 45% and 75%. Seventy-five percent of patients with liver metastasis had stage IV disease at diagnosis and were more likely to have abnormal LFTs than other stages (P = .048). In these patients, 2.2% (8/365) had liver metastases and abnormal LFTs, whereas 1.9% (7/365) had liver metastases and normal LFTs. Sensitivity for alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, and lactate dehydrogenase 0%, 10%, 20%, and 30%, respectively. Specificities ranged from 88.0% to 94.3%. Positive predictive values were poor, with the highest being 10.5%. Liver metastases are rare in HNSCC and often delayed in presentation. This study clearly reveals that LFTs do not reliably identify patients with liver metastasis and do not provide physicians with an adequate screening modality in this population.