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Diagnosis of Metastatic Liver Cancer-Reply

Edward B. Silberstein, MD
JAMA. 1984;252(10):1280. doi:10.1001/jama.1984.03350100013011.
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In Reply.—  I agree with Drs Franco and Schwartz on all points except that of a possible bias toward nuclear medicine.There are quite a number of studies comparing ultrasound, CT, and the radionuclide liver scan in the diagnosis of hepatic metastases, which we have found in preparing a review to be submitted for publication shortly. In comparing modalities, it is important that the instruments being examined are all state-of-the-art equipment at the time of publication so that there is no bias in favor of one modality. The study cited by Franco and Schwartz as a Belgian study (which is actually from Holland) employs a second-generation CT instrument that is obsolete at this time. Similarly, their reference 4 does not indicate which instruments were involved in the radionuclide liver scanning or CT, so, once again, extrapolation of the data is difficult. However, in the fine study performed by Alderson et

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