More Accurate Diagnosis of Some Liver Diseases Using Alpha-Fetoprotein (AFP) Levels: Presented at ASCP

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Accurate Diagnosis of Some Liver Diseases Using Alpha-Fetoprotein (AFP) Levels:

Presented at ASCP

NEW ORLEANS, LA

-- October 23, 2007 --

Serum alpha-fetoprotein (AFP) levels above700 ng/dL

appear to be diagnostic of hepatocellular carcinoma

(HCC), researchers reported here at the American Society of Clinical

Pathologists (ASCP) Annual Meeting.

The current literature cites a range of AFP values from above 20 ng/dL to 400 mg/dL as being

associated with HCC; levels above that are reported as being diagnostic of HCC. The findings of a new study trying to establish a more

accurate range for HCC screening were presented.

To establish a more accurate range of AFP values for HCC screening, Todd LeLeux, MD, Resident Pathologist, E. DeBakey VA Medical Center, Houston,

Texas, United States,

and colleagues performed a retrospective chart review of patients who had been

tested for AFP at their institution in the previous 5 years.

Out of the total sample of 2,538 patients, the researchers identified 101

patients diagnosed with HCC who were then divided into three groups, based on

their AFP values. Patient records were reviewed for

tissue confirmation, clinical findings, X-rays, and follow-up.

Within the three groups, 18 patients had AFP < 20 ng/dL,

29 had AFP from 20-400 ng/dL, and 54 had AFP > 400

ng/dL. Diagnosis was made by

clinical presentation, radiography of the liver, and AFP values, for the most

part.

Incidence of hepatitis C virus infection (HCV) and alcoholic cirrhosis (ETOH)

varied with AFP values (49% HCV, 44% ETOH in < 20 ng/dL;

85% HCV, 10% ETOH in 20-400 ng/dL; 98% HCV, 5% ETOH

in > 400 ng/dL). The

diagnosis of HCC was made by FNA, liver biopsy, or radiography. There were eight cases of metastatic

carcinomas and one germ cell tumour.

Only AFP values > 700 ng/dL were indicative

of HCC, in the absence of a germ cell tumour.

In patients with AFP values between 400 and 700 ng/dL,

five did not have HCC. These had nonalcoholic steatohepatitis (NASH), hepatorenal

syndrome, and interferon therapy. The patients without

HCC who had AFP values > 100 ng/dL had alcoholic

hepatitis, liver failure, cirrhosis, and interferon therapy.

Values of AFP can be increased by factors such as cirrhosis, interferon

therapy, alcoholic hepatitis, nonalcoholic steatohepatitis,

hepatorenal syndrome, germ cell tumours,

and metastatic carcinomas.

The study findings showed that values > 400 ng/dL

are suggestive but not diagnostic of HCC, the researchers said. In patients with HCC, AFP values < 20 ng/dL have a strong correlation to ETOH alone. Values > 20 ng/dL are

associated with HCV, with or without ETOH.

Dr. LeLeux said, " We concluded that AFP values

> 700 ng/dL were diagnostic of HCC in a sample of

patients dominated by men with HCV-related liver disease. Lower

values cannot be used to make a definitive diagnosis of HCC without radiography

or biopsy. "

Barb in Texas - Together in the Fight, Whatever it Takes!

Son Ken (33) UC 91 - PSC 99 - Tx 6/21 & 6/30/07 @ Baylor in Dallas