Phillips P J, Rowland R, Reid D P, Coles M E
J Clin Pathol. 1977 Dec;30(12):1129-33. doi: 10.1136/jcp.30.12.1129.
A rational comparison of different serum concentrations of alpha1-fetoprotein (S-AFP) in the diagnosis of hepatoma must be made. We took data on the sensitivity and specificity of different diagnostic S-AFP concentrations from the literature and evaluated them statistically and by Bayesian analysis. In our patients (hepatoma prevalence 0.028) a sensitive diagnostic concentration (30-50 ng/ml) will misdiagnose hepatoma so often that a positive test will indicate hepatoma in only 10% of cases. A positive test at a specific diagnostic concentration (500 ng/ml) indicates hepatoma in 100% of cases and is preferable in terms of cost benefit. Although the lower concentration will diagnose a larger proportion of patients with hepatoma (74% compared with 59%) the 'costs' of excluding false positives are considerable (A$2545 per extra case with 2.5% of patients suffering significant morbidity). In western societies, where the prevalence of hepatoma is low, a higher, less sensitive but more specific diagnostic S-AFP concentration is appropriate.
必须对不同血清甲胎蛋白（S-AFP）浓度在肝癌诊断中的应用进行合理比较。我们从文献中获取了不同诊断性S-AFP浓度的敏感性和特异性数据，并通过统计学方法和贝叶斯分析对其进行评估。在我们的患者中（肝癌患病率为0.028），一个敏感的诊断浓度（30 - 50纳克/毫升）会经常误诊肝癌，以至于阳性检测结果仅在10%的病例中提示肝癌。在一个特定诊断浓度（500纳克/毫升）下的阳性检测结果在100%的病例中提示肝癌，并且从成本效益角度来看更可取。尽管较低浓度能诊断出更大比例的肝癌患者（74%，相比之下为59%），但排除假阳性的“成本”相当高（每多诊断一例需花费2545澳元，且有2.5%的患者）。在肝癌患病率较低的西方社会，较高的、敏感性较低但特异性较高的诊断性S-AFP浓度是合适的。
