title: Validity of alpha fetoprotein for diagnosis of hepatocellular carcinoma in cirrhosis.
abstract: OBJECTIVE
  To determine the accuracy of serum alpha fetoprotein (AFP) for diagnosis of hepatocellular carcinoma (HCC) in patients with cirrhosis.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Department of Medicine, The King Edward Medical University, Lahore, from November 2007 to August 2011.
  
  
  METHODS
  Consecutive patients, diagnosed with HCC by contrast enhanced CT, MRI or biopsy were included as cases. Patients of cirrhosis with no evidence of HCC were enrolled as controls. Demographic, laboratory and radiological data were recorded. Serum AFP was determined in all patients at outset and was analyzed using ROC curve for its accuracy in diagnosing HCC.
  
  
  RESULTS
  A total of 275 patients were included; of them 173 had HCC and 102 had cirrhosis. One hundred and thirty nine cases (80.3%) with HCC and 86 (84.3%) without HCC had cirrhosis due to HCV. Stage of liver disease, as determined by Child Turcotte Pugh (CTP) score, was comparable; mean CTP value 7.97 ± 2.17 in HCC and 7.75 ± 2.21 in control group (p = 0.41). Area under curve (AUC) for AFP was 0.85 (95%, CI: 0.80 - 0.90) with optimum cut off value of 20.85 ng/ml which showed 72.2% sensitivity, 86.2% specificity, 89.9% positive predictive value, 64.7% negative predictive value and 77.4% overall accuracy in diagnosing patients with HCC.
  
  
  CONCLUSIONS
  Despite sub-optimal sensitivity, alpha fetoprotein is still a valid screening test for diagnosis of hepatocellular carcinoma till other more sensitive markers are developed. Till then, it should be used in conjunction with ultrasound.
authors.affiliation: Department of Medicine, King Edward Medical University, Lahore.
authors.forename: Shahid
authors.initials: S
authors.lastname: Sarwar
authors.affiliation: Department of Gastroenterology, Shaikh Zayed Postgraduate Medical Institute, Lahore.
authors.forename: Anwaar Ahmad
authors.initials: AA
authors.lastname: Khan
authors.affiliation: Department of Medicine, King Edward Medical University, Lahore.
authors.forename: Shandana
authors.initials: S
authors.lastname: Tarique
mesh_terms: D000328:Adult; D000368:Aged; D019540:Area Under Curve; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis*; D016022:Case-Control Studies; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000097:blood* / Q000150:complications / Q000175:diagnosis; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012372:ROC Curve; D012680:Sensitivity and Specificity; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins