Mass screening of primary hepatocellular carcinoma by alpha‐fetoprotein in a rural area of Taiwan – a dried blood spot method

Abstract

ABSTRACT— A prospective survey of primary hepatocellular carcinoma (PHC) was conducted in a rural area of Taiwan using a two‐site enzyme immunoassay for alphafetoprotein (AFP) in dried blood samples collected on filter paper. Of 1894 men over 40 years of age who were tested, 20 (1%) had AFP levels of greater than 20 ng/ml of blood on screening. Nineteen of these men received ultrasound examinations, and small PHCs were detected in 4 (21%). The remaining 15 cases had other types of hepatobiliary tract diseases, and 6 (40%) were also serum HBsAg positive. They should all be closely followed up by AFP determination and ultrasound examination of the liver. In contrast to the low resection rate of PHC in symptomatic patients who were admitted through the outpatient clinic during the period of this survey, the four cases with small PHC discovered by AFP screening had their tumors successfully removed (5/57 vs. 4/4, p<0.005). Our preliminary results showed that this method is a simple, sensitive and convenient assay for AFP and may be used as a first‐line screening test in mass population surveillance programs for PHC, particularly in areas where PHC is highly prevalent.

Community-Based Mass Ultrasonographic Screening of Hepatocellular Carcinoma among Thrombocytopenic Adults

“…Cost of screening tools, sensitivity of the screening tests, and PPV of the high-risk group are all important issues. In the earliest study (model 1), the subjects with elevated AFP were referred to a hospital for further examination after the entire community's screening for AFP (11). Although it is easy to collect blood samples in community, AFP alone should not be recommended for screening (15).…”

“…Although some community-based HCC screening projects have been reported previously (5, 9-13), it has not been routine. In earlier communitybased screenings, subjects with elevated a-fetoprotein (AFP) were referred to hospitals for further examination after an entire community had been screened for AFP (9)(10)(11). It is relatively easy to collect blood samples in the traditional or filter paper methods and send them back to the AFP laboratory (10,11).…”

Analysis of urinary nucleosides as helper tumor markers in hepatocellular carcinoma diagnosis

“…Prompt treatment improves the rates of survival for patients, which suggests the need for screening and early detection of HCC 3, 4. The routine screening of patients with HCC by determining α ‐fetoprotein (AFP) levels can be used to identify those who should be referred to the hospital for further examination 5–7. Although detection of AFP by enzyme‐linked immunoassay is a simple laboratory test, it alone is neither sensitive nor specific enough for diagnosis of HCC; and abdominal sonography is performed to confirm HCC diagnosis 8, 9.…”

α-Fetoprotein assay on dried blood spot for hepatoblastoma screening in children with overgrowth-cancer predisposition syndromes

“…This approach has already been attempted in other situations: as a second tier test for tyrosinemia newborn screening (26), as a screening for fetal neural tube defects and trisomy 21 in pregnancy (27)(28)(29), and for liver adenocarcinoma mass screening in adults (30). In this study, we adapted the method for αFP plasmatic measurement to blood dried on standard newborn screening filter paper and studied its reliability by comparing it with the traditional method, in both blood of patients with hepatoblastoma predisposition syndromes and controls.…”