title: [Clinical significance of transiently elevated serum AFP level in developing hepatocellular carcinoma in HBsAg positive-liver cirrhosis].
abstract: OBJECTIVE
  Serum alpha fetoprotein (alpha-FP) measurement has a limitation to detect hepatocellular carcinoma (HCC) because it is elevated in various liver diseases. Therefore, we studied the sensitivity and specificity of high alpha-FP in the diagnosis of HCC.
  
  
  METHODS
  We studied 253 patients with HBsAg positive liver cirrhosis prospectively. We analyzed incidence of HCC related cut-off values of serum alpha-FP levels. During the follow-up period, we analyzed sensitivity and specificity of cut-off values of alpha-FP for the diagnosis of HCC, and alpha-FP elevation rate in relation to mass size.
  
  
  RESULTS
  One hundred and twenty-five patients had a transient elevation of alpha-FP levels above 20 ng/mL. The corresponding incidences of HCC were 27.2% (34/125) and 15.6% (20/128 patients without elevation of alpha-FP), respectively with a statistically significant difference (p=0.03). Among 54 patients with HCC, 18 patients (33.0%) had levels of alpha-FP below 20 ng/mL on the time of diagnosis of HCC. When we defined cut-off values of serum alpha-FP as 20, 100 and 500 ng/mL, the corresponding sensitivity and specificity for HCC were 62.9% and 24.0%, 7.4% and 54.2%, 77.3% and 91.9%, respectively. We studied sensitivity according to cut-off values of alpha-FP defined as 20, 100, 200, 500 ng/mL in patients with small HCC below 2 cm. The corresponding sensitivity were 50.0%, 43.7%, 25.0%, 18.7%, respectively. In patients with levels of serum alpha-FP below 20 ng/mL, percentages of mass size less than 2 cm, 2~3 cm, 3~5 cm and more than 5 cm were 50.0%, 25.0%, 28.5% and 25.0%, respectively.
  
  
  CONCLUSIONS
  We suggested that in order to detect HCC, careful periodic monitoring with alpha-FP, ultrasonography and abdominal computed tomography is needed in patients with HBsAg positive liver cirrhosis and whose serum level of alpha-FP is above 20 ng/mL.
authors.affiliation: Department of Internal Medicine, Chungnam National University College of Medicine, 640 Daesa-dong, Jung-gu, Daejeon 301-721, Korea. leehy@hanbat.chungnam.ac.kr
authors.forename: Heon Young
authors.initials: HY
authors.lastname: Lee
authors.forename: Jae Hoon
authors.initials: JH
authors.lastname: Jung
authors.forename: Yoon Sae
authors.initials: YS
authors.lastname: Kang
authors.forename: Yeon Soo
authors.initials: YS
authors.lastname: Kim
authors.forename: Hee Seok
authors.initials: HS
authors.lastname: Moon
authors.forename: Ki Oh
authors.initials: KO
authors.lastname: Park
authors.forename: Yeum Seok
authors.initials: YS
authors.lastname: Lee
authors.forename: Seon Mun
authors.initials: SM
authors.lastname: Kim
authors.forename: Seung Won
authors.initials: SW
authors.lastname: Seo
authors.forename: Sang Woo
authors.initials: SW
authors.lastname: Lee
authors.forename: Seok Hyun
authors.initials: SH
authors.lastname: Kim
authors.forename: Byung Seok
authors.initials: BS
authors.lastname: Lee
authors.forename: Nam Jae
authors.initials: NJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000032:analysis; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D005260:Female; D006514:Hepatitis B Surface Antigens / Q000097:blood*; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000821:virology; D008113:Liver Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D008297:Male; D008875:Middle Aged; D012680:Sensitivity and Specificity; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D014408:Biomarkers, Tumor; D006514:Hepatitis B Surface Antigens; D000509:alpha-Fetoproteins