Samir Gupta, MD; Stephen Bent, MD; Jeffrey Kohlwes, MD, MPH
Patients with hepatitis C virus (HCV) are at increased risk for hepatocellular carcinoma. Although serum -fetoprotein (AFP) is often used to detect hepatocellular carcinoma in HCV-infected individuals, its utility is unclear.
To define the test characteristics of AFP for the diagnosis of hepatocellular carcinoma in patients with HCV.
MEDLINE search from 1966 to December 2002 for English- and nonEnglish-language articles examining the test characteristics of AFP for identifying hepatocellular carcinoma.
Articles were included if they reported the sensitivity and specificity of AFP for detecting hepatocellular carcinoma in patients with HCV. Articles were excluded if the cause of hepatitis was ambiguous or if 50% or more of the study patients did not have HCV.
Relevant articles were evaluated for quality of evidence; test characteristics were abstracted and calculated.
Five studies met all inclusion criteria and were analyzed. The overall quality of evidence was limited; only one study universally applied an acceptable gold standard test, and three of five studies used a casecontrol design that potentially overestimates diagnostic accuracy. By using the most commonly reported cutoff value of a positive test result for hepatocellular carcinoma (AFP level > 20 g/L), the ranges of test characteristics were as follows: sensitivity, 41% to 65%; specificity, 80% to 94%; positive likelihood ratios, 3.1 to 6.8; and negative likelihood ratios, 0.4 to 0.6.
The paucity of high-quality data calls for more rigorous study of AFP and other diagnostic tests for detecting hepatocellular carcinoma in HCV-infected patients with an accepted gold standard applied to the entire cohort. Even if the best-case estimates of AFP sensitivity and specificity are accurate, AFP has limited utility for detecting hepatocellular carcinoma.
The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.
Gupta S, Bent S, Kohlwes J. Test Characteristics of α-Fetoprotein for Detecting Hepatocellular Carcinoma in Patients with Hepatitis C: A Systematic Review and Critical Analysis. Ann Intern Med. 2003;139:46–50. doi: 10.7326/0003-4819-139-1-200307010-00012
Download citation file:
Published: Ann Intern Med. 2003;139(1):46-50.
Gastroenterology/Hepatology, Gastrointestinal Cancer, Hematology/Oncology, Infectious Disease, Liver Cancer.
Results provided by:
Copyright © 2017 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only