Alpha feto-protein and albumin in ascitic fluid in hepatocellular carcinoma patients.

Alpha-feto-protein (AFP) is the most popular tumor marker for hepatocellular carcinoma (HCC). It is used in diagnosis and follow up of cases by estimating its rise in the serum. The aim of this work is to study the value of estimating AFP in ascitic fluid of HCC patients with ascites. This work is a case control study on 32 patients, including 22 cases with ascites and HCC and 10 control group with ascites due to liver cirrhosis without HCC. The level of AFP was estimated in serum and in ascitic fluid by Radio-immuno assay RIA. The serum ascites albumin gradient (SAAG) was assessed by measuring albumin in all samples using bromocresole green dye binding. Guided aspiration liver biopsy and ascitic fluid cytology was done, stained with H & E. It was found that, AFP level in serum was elevated in 72.7% of HCC patients, and in ascitic fluid was elevated 63.6% HCC patients. Also, there was a highly significant, direct positive correlation between elevation of AFP in serum and in ascitic fluid (r = 0.778). No elevation of AFP in serum and in ascitic fluid was detected in control group. Ascitic fluid cytology showed malignant cells in one case only. SAAG was significantly lower in the HCC group 0.83 gm/dl than the control group 2.43 gm/dl (p-value < 0.001). Elevation of AFP in ascitic fluid is of high importance in evaluation of HCC, and is as significant as serum and runs parallel to it. Estimation of AFP in ascitic fluid is much more significant in evaluation of HCC cases than ascitic fluid cytology.