Alpha fetoprotein, ultrasound, computerized tomography and magnetic resonance imaging for detection of hepatocellular carcinoma in patients with advanced cirrhosis

Abstract

SUMMARY BackgroundSerum alpha fetoprotein (AFP), ultrasound, computerized tomography scanning, and magnetic resonance imaging are commonly used to screen for hepatocellular carcinoma (HCC) in patients with cirrhosis.

Early alpha‐fetoprotein response predicts treatment efficacy of antiangiogenic systemic therapy in patients with advanced hepatocellular carcinoma

“…16 Previous studies have demonstrated that the baseline AFP level is a significant prognostic factor for various stages of HCC. [16][17][18][19][20][21][22] Recently, Chan and colleagues reported that a decline in the post-treatment AFP level was associated with radiologic tumor response and survival in patients with advanced HCC who received doxorubicin-based combination chemotherapy. 23 Vora et al also reported that post-treatment AFP changes were closely associated with clinical outcomes in patients who received various types of systemic therapy.…”

Clinical significance of tumor markers in detection of recurrent hepatocellular carcinoma after radiofrequency ablation

“…In order to improve the specificity of AFP in the diagnosis of HCC, AFP-L3 has been developed. AFP-L3 levels had sensitivities and specificities that ranged from 36-96% and 89-94%, respectively, though for the diagnosis of small HCCs, the specificity is relatively low, around 20% (20,28). Pre-treatment AFP-L3 values have also been reported to be correlated with poorly differentiated cancer and poor prognosis (40,41).…”

“…Overall, AFP and DCP have nearly equal sensitivity, although DCP has higher specificity (23)(24)(25)(26). We set the cut-off level of AFP-L3 and DCP as 10% and 40 mAU/ml, respectively, based on previous reports (20,(23)(24)(25)(26)28,40,41).…”

“…The higher the AFP cut-off level, the higher the specificity and the lower the sensitivity (37)(38)(39). We set the cut-off level of AFP as 100 ng/ml, based on a review of several papers (9,15,28,29) that reported that this level is suitable for detecting HCCs. In order to improve the specificity of AFP in the diagnosis of HCC, AFP-L3 has been developed.…”

“…Previous reports have detailed the usefulness of each of these tumor markers in the early detection and diagnosis of HCC, the evaluation of tumor progression, and the determination of patient prognosis (21)(22)(23)(24)(25)(26), although these tumor markers do not demonstrate high positivity in patients with small (e.g., less than 2 cm in maximum diameter) HCC (27,28). Of these, AFP shows relatively low specificity (29) because AFP increases in association with hepatocyte regeneration and is also associated with serum alanine aminotransferase activity (9).…”