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May 4, 1957


JAMA. 1957;164(1):22-28. doi:10.1001/jama.1957.02980010024006

• The presence or absence of either hepatic metastasis or common bile duct pathology in anicteric patients can be predicted with a high degree of accuracy by determination of the serum alkaline phosphatase level. Studies were carried out in 234 cancer patients and in 190 patients with gallbladder disease. When the test was done preoperatively in 103 patients with intraabdominal malignancy, normal values were obtained in 65, and only 4 of these were found at operation to have hepatic metastases; elevated values were found in 38, and 32 of these proved to have hepatic metastases. A similar association of hyperphosphatasemia with hepatic metastases was found in 56 patients with extraabdominal malignancy. The alkaline phosphatase level was also helpful in gauging the progress and prognosis of 75 patients with previously resected neoplasm. Among 81 anicteric patients tested before cholecystectomy, the alkaline phosphatase accurately predicted the status of the common bile duct in 74 and was of comparable value in evaluating 89 patients whose gallbladder had previously been removed. Comparison of this test with direct bilirubin and the sulfobromophthalein tests showed it to be the most accurate of the three in the detection of either hepatic metastasis or obstruction of the common bile duct in patients free of jaundice.