Liver Scans to Detect Metastases

To the Editor.—  We read with great interest the article entitled "Liver Scanning in Patients With Suspected Abdominal Tumor" by Fee and others (230:1675, 1974). However, we would like to comment on their result. The techniques to evaluate hepatic metastases at laparotomy are several; namely, simple inspection and palpation, needle biopsy, and marginal wedge biopsy. Fee et al mentioned that at exploratory laparotomy, the liver was examined (we presume by inspection and palpation) in every case and biopsies performed in questionable cases (not in all cases). In our experience, patients with a positive liver scan had a perfectly normal liver by inspection and palpation, but biopsy (needle or marginal wedge type) indicated an abnormal liver. So, if the scan was positive and the surgeon inferred a normal liver on the basis of only inspection and palpation, it would be wrong to term the scan as false-positive. With needle or wedge