Abstract
Alpha-fetoprotein in Liver Cancer Screening: Its Significance among High-risk Populations with No Tumor Detected on Liver Ultrasound
Perillo, Engelbert Simon1,2; Wong, Stephen N.1,2
Chinese General Hospital and Medical Center; 2 University of Santo Tomas Hospital
Significance: Several guidelines have removed alpha-fetoprotein (AFP) from their hepatocellular carcinoma (HCC) screening recommendations. However, ultrasound is subjective to interpretive error. We aimed to determine the frequency of missed HCC diagnosis in patients with elevated AFP and compare these patients with false positive elevated AFP.
Methodology: This is a retrospective study done over a 10-year period. Patients with elevated AFP done within 12 weeks of an ultrasound with no detected tumor were included. Diagnosis of HCC was confirmed/excluded either by dynamic imaging/biopsy done within 12 weeks of ultrasound, or by serial ultrasound monitoring of at least 12 months. Demographics and laboratory data were compared between patients with and without HCC.
Results: Out of 469 patients with elevated AFP, 103(22%) had normal ultrasound and were included in the study. The rest were excluded due to the presence of hepatic mass/es on ultrasound.
Conclusion: More than a quarter of patients with elevated AFP without tumor on ultrasound were found to have HCC on further evaluation. The presence of cirrhosis and an infiltrative HCC-morphology may interfere with the accuracy of ultrasound. This highlights the pitfall of excluding AFP as part of HCC screening.
Important Dates to Remember
| JRRE Activities 2023-2024 |
Proposed Dates |
|---|---|
| Resumption of face-to-face Evidence-Based Medicine Workshop Venue to be announced once finalized. |
July 21, 2023 (Friday), 1-5pm |
| Monthly Critical Appraisal of Topics Conferences to be gaciliated by Research Coordinators per Institution | Monthly Critical Appraisal of Topics Conferences per Institution |
| CAT Plenary/Liver Con Dates: September 23, 2023 December 16, 2023 March 2024 (During the JAC) Resumption of face-to-face Quarterly Critical Appraisal of Topics facilitated by the JRRE |
2 Clinical scenarios and articles are to be sent to institutions each on August 2023, November 2023, and February 2024; |
| Hybrid Research Workshop 4 week asynchronous via Moodle, followed by a 1 day on-site Onsite Workshop Research Protocol Presentation for Level I GI Fellows-In-Training - Research Protocol Presentation: August 12, 2023 - Research Forums of the Tripartite Societies |
Week 1: July 15-21, 2023 Week 2: July 22-28, 2023 Week 3: July 29-August 4, 2023 Week 4: August 5-11, 2023 |
| Research Manuscript Workshop for level II GI Fellows-In-Training | January 6, 2024 |