Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Liver Int. 2011 Nov;31(10):1468-76. doi: 10.1111/j.1478-3231.2011.02529.x. Epub 2011 Apr 11.
Noninvasive criteria for diagnosing hepatocellular carcinoma (HCC) suggested by the American Association for the Study of Liver Diseases (AASLD) in 2005 consisted of serum α-fetoprotein (AFP) level >200 ng/ml or a typical enhancement pattern (arterial enhancement and portal/delayed washed out) on dynamic imaging of hepatic mass(es) >2 cm in a cirrhotic liver.
To validate these criteria in a Korean population and to evaluate whether these criteria are applicable to patients without cirrhosis at a high risk of developing HCC.
We prospectively investigated 206 consecutive patients with hepatic mass(es) >2 cm who underwent biopsy or surgical resection. Patients were evaluated by four-phase dynamic computed tomography (CT) and by assays of serum AFP concentrations at baseline. Patients were classified according to the presence of risk factors or cirrhosis, and the diagnostic accuracy of each test was determined.
The positive predictive values (PPV) of typical CT findings or serum AFP >200 ng/ml were 97.8% in cirrhotic patients, 89.6% in high-risk patients without cirrhosis and 82.4% in low-risk patients. The PPVs of typical CT findings alone in these groups were 98.8, 97.6 and 87.5% respectively. In high-risk patients without cirrhosis, the addition of serum AFP levels to typical CT findings minimally increased the diagnostic sensitivity from 81.6 to 87.8% but reduced the PPV from 97.6 to 89.6%.
Serum AFP concentration is not a suitable diagnostic criterion for HCC. Typical CT findings can be used to diagnose HCC >2 cm both in cirrhotic patients and in high-risk patients without cirrhosis.
2005 年，美国肝病研究学会（AASLD）提出的用于诊断肝细胞癌（HCC）的非侵入性标准包括血清甲胎蛋白（AFP）水平>200ng/ml 或在肝硬化肝脏中>2cm 的肝肿块的动态影像学上呈典型增强模式（动脉期增强和门脉/延迟洗脱）。
在韩国人群中验证这些标准，并评估这些标准是否适用于发生 HCC 风险高但无肝硬化的患者。
我们前瞻性研究了 206 例>2cm 的肝肿块连续患者，这些患者接受了活检或手术切除。通过四期动态计算机断层扫描（CT）和基线时的血清 AFP 浓度检测对患者进行评估。根据危险因素或肝硬化的存在对患者进行分类，并确定每种检查的诊断准确性。
在肝硬化患者中，典型 CT 表现或血清 AFP>200ng/ml 的阳性预测值（PPV）为 97.8%，在无肝硬化的高危患者中为 89.6%，在低危患者中为 82.4%。在这些组中，典型 CT 表现单独的 PPV 分别为 98.8%、97.6%和 87.5%。在无肝硬化的高危患者中，将血清 AFP 水平添加到典型 CT 表现中仅将诊断敏感性从 81.6%提高到 87.8%，但将 PPV 从 97.6%降低到 89.6%。
血清 AFP 浓度不是 HCC 的合适诊断标准。典型的 CT 表现可用于诊断肝硬化患者和无肝硬化的高危患者中>2cm 的 HCC。
