title: Ultrasound-guided fine needle biopsy of intrahepatic nodules and low elevation of AFP in early diagnosis of hepatocellular carcinoma.
abstract: BACKGROUND
  With the progress in early clinical treatment of hepatocellular carcinoma (HCC), early detection and diagnosis of HCC have been increasingly pressing. Combined alpha-fetoprotein(AFP) determination and ultrasonography has become the main method for the detection of small HCC; but the relationship between low elevation of AFP and pathologic findings of small HCC has not been well defined. The aim of this study was to assess the value of ultrasound-guided fine needle biopsy of intrahepatic nodules and low elevation of serum AFP in the early diagnosis of HCC.
  
  
  METHODS
  Fifty-nine patients with serum AFP exceeding 20 ng/ml and intrahepatic nodules varying from 0.8 cm to 5.0 cm in diameter who had been detected by ultrasonography underwent ultrasound-guided percutaneous fine needle biopsy, and cytological staining and histological sectioning were performed at the same time.
  
  
  RESULTS
  Among the 59 patients, 11 patients (18.6%) showed AFP level above 400 ng/ml, 5 (8.5%) from 200 ng/ml to 400 ng/ml, 18 (30.5%) from 50 ng/ml to 200 ng/ml and 25 (42.4%) from 20 ng/ml to 50 ng/ml. Follow-up demonstrated that 53 patients (89.8%) had a progressive increase of AFP level. In 58 patients (98.3%) cancer cells were found by cytological staining and/or histological sectioning.
  
  
  CONCLUSIONS
  In those patients with slightly increased or continuously positive AFP, hepatic carcinoma should be highly suspected when AFP increases gradually and intrahepatic nodules are detected by ultrasonography in follow-up. Once intrahepatic carcinoma nodules are suspected, ultrasound-guided fine needle biopsy should be performed as early as possible for early diagnosis and treatment.
authors.affiliation: Department of Ultrasonography, Union Hospital of Fujian Medical University, Fujian Provincial Ultrasonic Medical Institute, Fuzhou 350001, China. rosehe5893@vip.sina.com
authors.forename: Yi-Mi
authors.initials: YM
authors.lastname: He
authors.forename: Xiao-Yan
authors.initials: XY
authors.lastname: Wang
authors.forename: Shang-Da
authors.initials: SD
authors.lastname: Gao
authors.forename: Li-Yun
authors.initials: LY
authors.lastname: Yu
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Lin
authors.forename: Li-Wu
authors.initials: LW
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D044963:Biopsy, Fine-Needle / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging* / Q000473:pathology*; D015331:Cohort Studies; D042241:Early Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007150:Immunohistochemistry; D008113:Liver Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D014408:Biomarkers, Tumor; D000509:alpha-Fetoproteins