title: Accuracy of the preoperative determination of tumor markers in the differentiation of liver mass lesions in surgical patients.
abstract: OBJECTIVE
  The diagnostic accuracy of tumor markers for differentiating focal liver lesions is not yet defined. Therefore, we carried out a retrospective analysis to address this issue.
  
  
  METHODS
  We retrospectively evaluated 192 consecutive patients with 289 focal liver lesions. The serum levels of AFP, PIVKA II, CEA, and CA19-9 were determined in 119 patients, while at least one of these values was lacking in the others. All patients underwent liver resection: 136 patients had hepatocellular carcinoma, 39 metastases, 9 cholangiocarcinoma, 1 mixed hepatocellular carcinoma-cholangiocarcinoma, and 7 benign lesions.
  
  
  RESULTS
  At least one of the tumor markers examined was elevated in 169 of the 185 patients with proven malignancy. In 92 cases, the elevation was marked. The mean levels of each tumor marker were significantly different among patients grouped according to the tumor type. ROC curves showed that 10 ng/mL was the optimal cut-off level for AFP and hepatocellular carcinoma, and for CEA and colorectal liver metastases. CEA and CA 19-9 showed specific patterns of elevation in liver metastases and cholangiocarcinoma.
  
  
  CONCLUSIONS
  Common tumor markers for focal liver lesions were significantly linked to the type of the tumor. These findings suggest that their selective estimation may be useful for the preoperative diagnosis of focal liver lesions.
authors.affiliation: Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. guido.torzilli@fastwebnet.it
authors.forename: Guido
authors.initials: G
authors.lastname: Torzilli
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Makuuchi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Ferrero
authors.forename: Tadatoshi
authors.initials: T
authors.lastname: Takayama
authors.forename: Ai-Min
authors.initials: AM
authors.lastname: Hui
authors.forename: Hideki
authors.initials: H
authors.lastname: Abe
authors.forename: Kazuto
authors.initials: K
authors.lastname: Inoue
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Nakahara
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000175:diagnosis; D001653:Bile Ducts, Intrahepatic; D015415:Biomarkers; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood; D002272:Carcinoembryonic Antigen / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis*; D018281:Cholangiocarcinoma / Q000175:diagnosis; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D011498:Protein Precursors / Q000097:blood; D011516:Prothrombin; D012372:ROC Curve; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D015415:Biomarkers; D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen; D002272:Carcinoembryonic Antigen; D011498:Protein Precursors; D000509:alpha-Fetoproteins; C008208:acarboxyprothrombin; D011516:Prothrombin