Noninvasive diagnostic criteria for hepatocellular carcinoma in hepatic masses >2 cm in a hepatitis B virus-endemic area

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http://onlinelibrary.wiley.com/doi/10.1111/j.1478-3231.2011.02529.x/abstract

Noninvasive diagnostic criteria for hepatocellular carcinoma in hepatic masses

>2 cm in a hepatitis B virus-endemic area

Sung Eun Kim1, Han Chu Lee1, Ju Hyun Shim1, Hyun Joo Park1, Kang Mo Kim1, Pyo

Nyun Kim2, Yong Moon Shin2, Eun Sil Yu3, Young-Hwa Chung1, Dong Jin Suh1Article

first published online: 11 APR 2011

DOI: 10.1111/j.1478-3231.2011.02529.x

© 2011 Wiley & Sons A/S

Issue

Liver International

Early View (Online Version of Record published before inclusion in an issue)

Abstract

Background: Noninvasive criteria for diagnosing hepatocellular carcinoma (HCC)

suggested by the American Association for the Study of Liver Diseases (AASLD) in

2005 consisted of serum á-fetoprotein (AFP) level >200 ng/ml or a typical

enhancement pattern (arterial enhancement and portal/delayed washed out) on

dynamic imaging of hepatic mass(es) >2 cm in a cirrhotic liver.

Aims: To validate these criteria in a Korean population and to evaluate whether

these criteria are applicable to patients without cirrhosis at a high risk of

developing HCC.

Methods: We prospectively investigated 206 consecutive patients with hepatic

mass(es) >2 cm who underwent biopsy or surgical resection. Patients were

evaluated by four-phase dynamic computed tomography (CT) and by assays of serum

AFP concentrations at baseline. Patients were classified according to the

presence of risk factors or cirrhosis, and the diagnostic accuracy of each test

was determined.

Results: The positive predictive values (PPV) of typical CT findings or serum

AFP >200 ng/ml were 97.8% in cirrhotic patients, 89.6% in high-risk patients

without cirrhosis and 82.4% in low-risk patients. The PPVs of typical CT

findings alone in these groups were 98.8, 97.6 and 87.5% respectively. In

high-risk patients without cirrhosis, the addition of serum AFP levels to

typical CT findings minimally increased the diagnostic sensitivity from 81.6 to

87.8% but reduced the PPV from 97.6 to 89.6%.

Conclusions: Serum AFP concentration is not a suitable diagnostic criterion for

HCC. Typical CT findings can be used to diagnose HCC >2 cm both in cirrhotic

patients and in high-risk patients without cirrhosis.