Surgical interventions for erroneous diagnoses of liver metastases]

Among 635 laparotomies carried out for liver metastases (LM) between June 1983 and December 1992, twenty three operations (with 6 hepatectomies) were performed for a false positive diagnosis of LM. They represented 3.6% of the whole population, but only 2.8% if the 5 patients operated for persistent diagnostic doubt are excluded. The 6 hepatectomies represented 2.2% of the 276 hepatectomies carried out for LM. The 23 false positive diagnosis of LM could be classified as follows: 14 complete errors (operation for the diagnosis of LM), 4 partial errors (the operation was also indicated for a concomitant disease), and 5 cases of real diagnostic doubt. Two groups of patients were differentiated according to the survey: one group had a regular survey and had a modification of their initial morphologic examinations of the liver, and one group had no reference morphologic examinations of the liver. The errors were more frequent in the first group. Atypical angiomas were the most frequent lesion (n = 10), followed by atypical cysts (n = 4), and nodular focal hyperplasia (n = 4): they represented 78% of all false positive diagnosis of LM. These false positive lesions were mainly detected in three carcinomas: colorectal carcinomas (n = 10), breast cancers (n = 5) and melanomas (n = 3): they represented 78% of the incorrect diagnosis. The relative frequency was high for melanomas (36%) and breast cancers (14%), but low for colorectal cancers (2%). The retrospective study of these cases shows that some errors could be eliminated by a more extensive imaging and systematic radio-clinical confrontation.(ABSTRACT TRUNCATED AT 250 WORDS)