Background:
The purpose of the current study was to assess the value of routine imaging and liver function tests in detecting metastases from malignant melanoma of the uvea.
Methods:
Forty-six consecutive patients diagnosed with metastatic uveal melanoma between 1985 and 1996 who had participated in a screening program that included annual liver function tests (lft), chest x-ray, and abdominal ultrasonography (us) were eligible for this retrospective cohort study. main outcome measures were the sensitivity of screening tests, presence of symptoms, recurrence free interval, and metastatic burden.
Results:
Metastases were diagnosed in 74% of patients (95% confidence interval [95% ci], 59-86) at screening and in 26% (95% ci, 14-41) when the patient consulted a physician because of symptoms that developed before the next scheduled visit. of all the patients, 59% (95% ci, 43-73) were asymptomatic, and 80% (95% ci, 66-91) had only hepatic metastases. the median recurrence free interval, greatest dimension of the largest metastasis, and metastatic burden of the two groups did not differ. us was diagnostic in 78% (95% ci, 64-89), at least 1 lft test was abnormal in 70% of patients (95% ci, 54-82), and a chest x-ray was abnormal in 2% of patients (95% ci, 0-12). lfts and us did not reveal hepatic metastases in 33% and 4% of patients, respectively. the sensitivity of individual lfts ranged from 0.27 to 0.67, and their specificity from 0.90 to 0.96, with lactate dehydrogenase being the most sensitive lft used.
Conclusions:
The authors believe that annual screening with lfts and abdominal us will identify 59% of patients while they are still asymptomatic and that semiannual screening will detect >95% of such patients. chest x-ray has a very low yield and is recommended only at baseline to exclude metastatic disease to the eye and if pulmonary symptoms develop.