Eskandar Hajiani, Seyed Jalal Hashemi, Mostafa Cheraghi,
Volume 8, Issue 1 (6-2006)
Abstract
Background: Hepatocellular carcinoma (HCC) is common all over the world as
well as Iran. The incidence of HCC is higher in hepatitis B carriers and it is highly
recommended to periodically screen these patients by serum alpha-fetoprotein (AFP)
and liver ultrasound (US) every 6 months. We explore the diagnostic accuracy and the
performance of (AFP) in cases of hepatitis B carriers as a screening tool by using
serum total AFP concentration of 20 ng/ml.
Materials and Methods: The study included 2452 HBsAg carriers with no
evidence of hepatocellular carcinoma or cirrhosis were followed up in a 6-year
prospective surveillance program with testing by ultrasound and alphafetoprotein
every 6 months referred to the Ahwaz JundiShapour university hospitals and hepatitis
clinic (1999-2004). Men and nonpregnant women with an elevated AFP level were
evaluated for the presence of HCC by ultrasound (US) examination. Hepatitis B
surface antigen (HBsAg), anti-HBc antibody and alpha-fetoprotein (AFP) were
determined in all cases by enzyme-linked immunosorbent assay (ELISA).
Findings: One or more AFP elevations (higher than 20 ng/ml) were found in 32
cases, but 13 (45%) hepatocellular carcinomas were detected in these patients during
follow up (9 men and 4 women). Of the 32 HBsAg carriers with AFP serum levels of
more than 20 ng/ml, HCC was not detected in 19 cases (65%). The positive predictive
value for AFP to detect HCC was only 31% for our AFP cut-off value, and the
sensitivity and specificity was approximately 56 and 88%, respectively.The positive
predictive value for ultrasound examinations to detect HCC was 64%, while the
sensitivity and specificity was 90 and 92%, respectively.
Conclusion: We conclude that AFP alone is not a useful marker for HCC screening
because of its poor predictive value and low sensitivity, particularly in patients with
underlying viral hepatitis B without cirrhosis and is not recommended except when
ultrasonography is either not available or of poor quality. Ultrasonography seems
more efficient and accurate as a screening tool.
