Ultrasound + AFP for early detection of HCC in patients with cirrhosis

Ultrasound (US) + alpha-fetoprotein (AFP) is better than ultrasound alone in the detection of hepatocellular carcinoma (HCC), as showed in a meta-analysis published in Gastroenterology.

The meta-analysis included 32 studies comprising 13367 patients.

When comparing ultrasound with vs without AFP measurement, sensitivity was lower for US alone vs US + AFP in detecting any stage HCC (relative risk [RR] 0.88; 95% confidence interval [CI]£ 0.83–0.93) or early-stage HCC (RR 0.81; 95% CI 0.71–0.93). However, US alone detected HCC with a higher level of specificity than US + AFP (RR 1.08; 95% CI 1.05–1.09). US + AFP vs without AFP detected early-stage HCC with 63% sensitivity (95% CI 48%–75%) and 45% sensitivity (95% CI 30%–62%), respectively (P = .002).

In 4 studies that evaluated CT or MR-based surveillance, 84% sensitivity (95% CI 70%–92%) was seen in HCC detection.

The meta-analysis concluded that addition of AFP to US significantly increases sensitivity of early HCC detection.

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