The value of currently available diagnostic techniques was assessed in 48 consecutive patients with primary hepatoma. Scintiscanning with98mTc sulphur-colloid was the most useful method, demonstrating tumours as‘filling defects’in 95 per cent of the cases in which scanning was carried out. An additional scan with75Se selenomethionine enabled most (72 per cent) of the hepatocellular carcinomas to be differentiated from the other histological types of hepatoma. Percutaneous needle biopsy of the liver when directed towards suspicious areas on the scan will enable a histological diagnosis to be made in the majority of patients and should be carried out much earlier than is usually done. Both hepatic arteriography and serum alpha-fetoprotein determination have too high an incidence of false-negative results for them to be used as primary diagnostic measures, and the main value of arteriography was to delineate arterial anatomy as a prelude to treatment by surgery or cytotoxic drug perfusion.The diagnosis of hepatoma was made before death by one or other of the above investigations in 42 (88 per cent) of the patients. However, in 25 per cent of the patients in whom the disease had been confirmed or suspected before death, the disease was already at such an advanced stage as to make treatment impracticable. The use of serial scintiscanning in patients at particular risk from primary hepatoma, namely those with cirrhosis, requires further evaluation but it is in this group that the diagnosis of developing hepatoma is most diffic
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