Clinical utility of lens culinaris agglutinin-reactive alpha-fetoprotein in the diagnosis of hepatocellular carcinoma: evaluation in a Thai referral population.
OBJECTIVE
There is no established clinical role for the lens culinaris agglutinin-reactive fraction of alpha-fetoprotein (AFP-L3%) in the management of the Thai hepatocellular carcinoma (HCC) patient population. The aim of this prospective study was to evaluate clinical utility and performance characteristics of AFP-L3% for the diagnosis of HCC in Thai referral patients.


METHODS
Sixty-one histologically proven HCC patients and 35 patients with other liver cancers were included for analysis.


RESULTS
The HCC population was comprised of 50 males and 11 females, with a mean age of 48.8 years. According to the Okuda system, three were classed as stage I, thirty-five belonged to stages II, and six were classified in stage III. An AFP-L3% a cut-off value of > 15% yielded a sensitivity of 82% (95% confidence interval [CI], 74-88%), specificity of 71% (95% CI, 58-82%), positive predictive value of 83% (95% CI, 75-90), and negative predictive value of 69% (95% CI, 56-80) for the diagnosis of HCC. In HCC patients with AFP of < 200 ng/ml, an AFP-L3% at a cut-off value of > 15% not only maintained high sensitivity of 83% and good specificity of 71% but also increased negative predictive value to 86% for the diagnosis of HCC.


CONCLUSIONS
AFP-L3% provides high sensitivity but with lower sensitivity in the diagnosis of HCC than total AFP in individuals with symptomatic liver mass. However, considering its high negative predictive value in patients with AFP < 200 ng/ml, AFP-L3% might be useful as an adjunctive marker, in combination with AFP, to exclude the presence of HCC.
Tanwandee
Tawesak
T
Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok, Thailand. sittw@mahidol.ac.th
Setthasin
Supatsri
S
Charatcharoenwitthaya
Phunchai
P
Chainuvati
Siwaporn
S
Leelakusolvong
Somchai
S
Pausawasdi
Nonthalee
N
Srikureja
Wichit
W
Pongprasobchai
Supot
S
Manatsathit
Sathaporn
S
Kachintorn
Udom
U
Ekpo
Patama
P
Senawong
Sunsanee
S
D006528:Carcinoma, Hepatocellular / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood* / Q000175:diagnosis* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D037121:Plant Lectins; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012017:Referral and Consultation; D013785:Thailand; D000509:alpha-Fetoproteins / Q000378:metabolism*
C097353:AFP protein, human; D037121:Plant Lectins; D000509:alpha-Fetoproteins; C033619:lentil lectin