ALPHA FETOPROTEIN;

USEFUL AS SCREENING TEST FOR HEPATOCELLULAR CARCINOMA DUE TO CHRONIC HEPATITIS C

Abstract

BACKGROUND: Hepatocellular carcinoma (HCC) is a primary tumor of the
liver, which develops in the setting of chronic liver disease, particularly in patients with chronic
hepatitis B and C in almost 80% patients. Although there are no specific screening tests for
diagnosis of HCC but alpha-fetoprotein (AFP) and abdominal ultrasound are commonly used.
AFP >400 ng/ml is considered diagnostic for HCC. Objective: The objective of study was
to validate the use of alphafetoprotein as screening test for HCC due to chronic HCV. Study
Design: Observational cross-sectional. Period: March 2014 to August 2016. Setting: Aziz
Bhatti Shaheed Teaching Hospital Gujrat. Materials and Methods: 134 patients aged >35
years having liver cirrhosis due to chronic HCV and diagnosed with HCC using biphasic CT
scan were included and were followed for 1 year. Serum AFP was divided in 3 categories and
a value < 20ng/ml - normal, 20-399 ng/ml - elevated and >400ng/ml - diagnostic of HCC.
Liver nodules size and site was noted and divided in 4 categories. Severity of liver disease
was calculated using Child Pugh Score. Analysis was done using SPSS 20.0. Results: AFP is
diagnostic (>400 ng/ml) in only 29.9% of patients with sensitivity of 43.3% at cut off value of
400 ng/ml and is significantly associated with severity of liver disease. Conclusion: AFP cannot
be used as screening test for HCC in patients with cirrhosis due to chronic HCV. Abdominal
ultrasound should be used for early detection of HCC due to chronic hepatitis C.