Criteria of Arrieta et al for the Diagnosis of Hepatocellular Carcinoma in a Patient with Cirrhosis Based on Serum Alpha Fetoprotein (AFP) Levels

 

Patient selection: presence of cirrhosis

 

Parameters:

(1) absolute level of alpha fetoprotein (AFP) in ng/mL

(2) rate (slope) of increase in serum AFP levels for 3 serial measurements

 

A serum AFP concentration >= 400 ng/mL was specific (100%) for hepatocellular carcinoma but insensitive (18%).

 

The schedule for doing the serial AFP measurements was not specified. The patients in the study were followed for 3 years. I would assume that the measurements were separated by several months.

 

A progressive increase in serum AFP >= 5 ng/mL per month was associated with hepatocellular carcinoma. The sensitivity was 76% and specificity 98%.

 

An alternative rule that may be less accurate but easier to calculate would be:

 

If (current AFP) - (baseline AFP) is >= 5 * (number if months between the measurements), then hepatocellular carcinoma should be suspected.

 

Limitation:

• The method for AFP determination is not specified and the normal reference range was not specified.