Improving peritoneoscopic staging of patients with solid tumors

Peritoneoscopy and guided needle biopsy were carried out as the staging procedure in patients with solid tumors. The disease was disseminated in 379 patients with various tumor types and limited in 109 with breast cancer and malignant melanoma. Adequate liver biopsies were obtained in all cases. Macroscopic liver tumors were demonstrated in 96 patients. Eleven additional patients had peritoneal or mesenteric tumors with normal livers. Attempts were made to improve the yield of positive findings of the procedure. The cytologic examination of cells adhering to the needle after biopsy or optimizing visualization of the liver surface by using a fiberoptic gastroscope did not answer this purpose. A 7.2% increase in liver tumor detection was obtained by taking 4-6 biopsies at random or towards deep palpated nodules in macroscopically normal livers. The data, although difficult to interpret in terms of accuracy of the method, suggest that in solid tumors random samplings of normal livers could contribute to the diagnosis of otherwise undetectable liver metastases.