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More Accurate Diagnosis of Some Liver Diseases Using Alpha-Fetoprotein (AFP) Levels: Presented at ASCP By Lexa W. Lee 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, Michael 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." [Presentation title: Screening AFP Levels in Hepatitis and ETOH Abuse in Patients in the US: What Is a Diagnostic or Suggestive Value? Poster 46] E-mail this page to a friend or colleague! To print, use this version