The utility of Lens culinaris agglutinin-reactive alpha-fetoprotein in the diagnosis of hepatocellular carcinoma: evaluation in a United States referral population.
OBJECTIVE
The percentage of Lens culinaris agglutinin-reactive (alpha)-fetoprotein (AFP-L3%) is proposed as a diagnostic and prognostic marker for hepatocellular carcinoma (HCC). We evaluated the utility of AFP-L3% for diagnosis of HCC in a US referral population.


METHODS
This retrospective study included 272 patients: 166 with HCC and 106 with benign liver disease (chronic liver disease, 77; benign liver mass, 29). The AFP-L3% was measured using a clinical auto-analyzer.


RESULTS
The AFP-L3% is not reported for a total alpha-fetoprotein (AFP) less than 10 ng/mL, and all patients with an AFP greater than 200 ng/mL had HCC; thus the AFP-L3% was noninformative for these patients. In patients with a total AFP of 10-200 ng/mL, an AFP-L3% greater than 10% had a sensitivity of 71% and a specificity of 63% for diagnosis of HCC. An AFP-L3% greater than 35% had a reduced sensitivity of 33%, but an increased specificity of 100%. The high specificity of the AFP-L3% cut-off of 35% allowed the confident diagnosis of an additional 10% of HCCs not diagnosed using an AFP cut-off of 200 ng/mL. After adjustment for AFP level, no association was observed between AFP-L3% and tumor size, stage, vascular invasion, grade, or survival.


CONCLUSIONS
Patients with indeterminate total AFP values of 10-200 ng/mL present a diagnostic dilemma. We found that an AFP-L3% greater than 35% has 100% specificity for HCC in these patients. AFP-L3%, used in combination with AFP, may be a clinically useful adjunct marker for the diagnosis of HCC.
Leerapun
Apinya
A
Miles and Shirley Fiterman Center for Digestive Diseases, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.
Suravarapu
Sri V
SV
Bida
John P
JP
Clark
Raynell J
RJ
Sanders
Elizabeth L
EL
Mettler
Teresa A
TA
Stadheim
Linda M
LM
Aderca
Ileana
I
Moser
Catherine D
CD
Nagorney
David M
DM
LaRusso
Nicholas F
NF
de Groen
Piet C
PC
Menon
K V Narayanan
KV
Lazaridis
Konstantinos N
KN
Gores
Gregory J
GJ
Charlton
Michael R
MR
Roberts
Rosebud O
RO
Therneau
Terry M
TM
Katzmann
Jerry A
JA
Roberts
Lewis R
LR
D000293:Adolescent; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood*; D001707:Biopsy, Needle; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008103:Liver Cirrhosis / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D037121:Plant Lectins; D011336:Probability; D011379:Prognosis; D012372:ROC Curve; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D016019:Survival Analysis; D014481:United States; D000509:alpha-Fetoproteins / Q000032:analysis / Q000378:metabolism*
D014408:Biomarkers, Tumor; D037121:Plant Lectins; D000509:alpha-Fetoproteins; C033619:lentil lectin