Alpha fetoprotein, ultrasound, computerized tomography and magnetic resonance imaging for detection

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Alimentary Pharmacology & Therapeutics 26 (9), 1187–1194.

doi:10.1111/j.1365-2036.2007.03498.x

Abstract

Alpha fetoprotein, ultrasound, computerized tomography and magnetic resonance

imaging for detection of hepatocellular carcinoma in patients with advanced

cirrhosis

N. SNOWBERGER**Department of Medicine, S. CHINNAKOTLA†,‡†Surgery, Baylor

University Medical Center, Dallas, TX, USA‡Baylor Regional Transplant Institute,

Dallas, TX, USA, R. M. LEPE*,‡*Department of Medicine‡Baylor Regional Transplant

Institute, Dallas, TX, USA, J. PEATTIE‡‡Baylor Regional Transplant Institute,

Dallas, TX, USA, R. GOLDSTEIN†,‡†Surgery, Baylor University Medical Center,

Dallas, TX, USA‡Baylor Regional Transplant Institute, Dallas, TX, USA, G. B.

KLINTMALM†,‡†Surgery, Baylor University Medical Center, Dallas, TX, USA‡Baylor

Regional Transplant Institute, Dallas, TX, USA & G. L. DAVIS*,‡*Department of

Medicine‡Baylor Regional Transplant Institute, Dallas, TX, USA*Department of

Medicine and †Surgery, Baylor University Medical Center, Dallas, TX, USA;

‡Baylor Regional Transplant Institute, Dallas, TX, USA

Dr G. L. , 4 , Hepatology, Baylor University Medical Center, 3500

Gaston Avenue, Dallas, TX 75246, USA.

E-mail: garydav@...

Summary

Background Serum alpha fetoprotein (AFP), ultrasound, computerized tomography

scanning, and magnetic resonance imaging are commonly used to screen for

hepatocellular carcinoma (HCC) in patients with cirrhosis.

Aim To assess the accuracy of screening in advanced cirrhosis.

Methods The study group consisted of 239 patients with proven HCC in the

explanted liver at the time of liver transplant. AFP and imaging were done at

referral and serially until transplant.

Results Hepatocellular carcinoma was detected before liver transplant in 78% and

discovered incidentally in 22%. The cause of cirrhosis was hepatitis C (HCV)

(55%), hepatitis B (HBV) (17%), alcohol (9%), and other/unknown (19%). Although

AFP was elevated 62%, the median level was 15 ng/mL. Only 26%, 15% and 13% were

more than 100, 400 and 1000 ng/mL, respectively. By comparison, AFP was elevated

in 20% without HCC, but exceeded 100 ng/mL in only 3%. The overall accuracy of

AFP was poor regardless of the cutoff. Magnetic resonance imaging was more

accurate than computerized tomography or ultrasound in detecting tumour,

particularly when performed within 3 months of transplant.

Conclusions Magnetic resonance imaging is most sensitive for imaging HCC and

best reflects actual tumour size. AFP is insensitive and adds little to

screening strategies, but has prognostic value when extremely elevated.

http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2036.2007.03498.x

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