Alpha fetoprotein improves ultrasound sensitivity for early HCC detection
Addition of alpha fetoprotein (AFP) to ultrasound significantly improves the detection of early stage hepatocellular carcinoma (HCC) in patients with cirrhosis, a recent meta-analysis has found.
Pooled results from 15 studies (n=4,400) showed that the sensitivity of ultrasound alone for detection of early stage HCC was 47 percent (95 percent CI, 33–61 percent). Sensitivity for detection at any stage, as assessed in 31 studies (n=12,977), was higher at 84 percent (76–92 percent).
Similarly, accuracy of ultrasound alone for HCC detection at early stages was low (area under the curve [AUC], 0.88; 0.85–0.90). Accuracy was higher for detection at any stage (AUC, 0.96; 0.94–0.98).
The findings were robust even after the inclusion of patients without cirrhosis, which did not cause significant changes in the sensitivity of ultrasound alone for early HCC detection (p=0.89).
Eighteen studies (n=8,526) directly compared ultrasound with and without AFP for the detection of HCC at any stage. The pooled sensitivity of ultrasound was significantly lower when used alone vs when used with AFP (78 percent vs 97 percent; relative risk [RR], 0.88; 0.83–0.93).
A similar trend was observed for detection of early-stage HCC using ultrasound alone vs in combination with AFP (45 percent vs 63 percent; RR, 0.81; 0.71–0.93). The beneficial effect of AFP was consistent across different subgroup analyses.
For the meta-analysis, the databases of Medline and Scopus were accessed for studies that monitored for HCC development using abdominal imaging with or without AFP. A total of 32 studies were eligible for inclusion, all of which were observational in nature.