1. The utility of Lens culinaris agglutinin-reactive alpha-fetoprotein in the diagnosis of hepatocellular carcinoma: evaluation in a United States referral population.
- Author
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Leerapun A, Suravarapu SV, Bida JP, Clark RJ, Sanders EL, Mettler TA, Stadheim LM, Aderca I, Moser CD, Nagorney DM, LaRusso NF, de Groen PC, Menon KV, Lazaridis KN, Gores GJ, Charlton MR, Roberts RO, Therneau TM, Katzmann JA, and Roberts LR
- Subjects
- Adolescent, Adult, Aged, Biopsy, Needle, Carcinoma, Hepatocellular blood, Carcinoma, Hepatocellular mortality, Carcinoma, Hepatocellular therapy, Case-Control Studies, Female, Humans, Immunohistochemistry, Liver Cirrhosis blood, Liver Cirrhosis diagnosis, Liver Cirrhosis mortality, Liver Cirrhosis therapy, Liver Neoplasms blood, Liver Neoplasms mortality, Liver Neoplasms therapy, Male, Middle Aged, Probability, Prognosis, ROC Curve, Referral and Consultation, Retrospective Studies, Risk Assessment, Sensitivity and Specificity, Survival Analysis, United States, alpha-Fetoproteins analysis, Biomarkers, Tumor blood, Carcinoma, Hepatocellular diagnosis, Liver Neoplasms diagnosis, Neoplasm Invasiveness pathology, Plant Lectins, alpha-Fetoproteins metabolism
- Abstract
Background & Aims: The percentage of Lens culinaris agglutinin-reactive (alpha)-fetoprotein (AFP-L3%) is proposed as a diagnostic and prognostic marker for hepatocellular carcinoma (HCC). We evaluated the utility of AFP-L3% for diagnosis of HCC in a US referral population., Methods: This retrospective study included 272 patients: 166 with HCC and 106 with benign liver disease (chronic liver disease, 77; benign liver mass, 29). The AFP-L3% was measured using a clinical auto-analyzer., Results: The AFP-L3% is not reported for a total alpha-fetoprotein (AFP) less than 10 ng/mL, and all patients with an AFP greater than 200 ng/mL had HCC; thus the AFP-L3% was noninformative for these patients. In patients with a total AFP of 10-200 ng/mL, an AFP-L3% greater than 10% had a sensitivity of 71% and a specificity of 63% for diagnosis of HCC. An AFP-L3% greater than 35% had a reduced sensitivity of 33%, but an increased specificity of 100%. The high specificity of the AFP-L3% cut-off of 35% allowed the confident diagnosis of an additional 10% of HCCs not diagnosed using an AFP cut-off of 200 ng/mL. After adjustment for AFP level, no association was observed between AFP-L3% and tumor size, stage, vascular invasion, grade, or survival., Conclusions: Patients with indeterminate total AFP values of 10-200 ng/mL present a diagnostic dilemma. We found that an AFP-L3% greater than 35% has 100% specificity for HCC in these patients. AFP-L3%, used in combination with AFP, may be a clinically useful adjunct marker for the diagnosis of HCC.
- Published
- 2007
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