In practice, we sometimes encounter the patients with chronic liver disease (CLD) who showed serum alpha-fetoprotein (AFP) above 400 ng/ml and no mass lesion in the liver on ultrasonogram. We enrolled 58 such patients, on whom abdominal CT and
hepatic
angiography were performed to determine the accompanying rate of superimposed HCC.
The initial serum ALT level and the subsequent changes of serum AFP levels of the patients with superimposed HCC were compared to those of the CLD patients without superimposed HCC to investigate the usefulness of these tests as simple and
noninvasive
diagnostic tool, which might replace the expensive and invasive tests such as abdominal CT and hepatic angiography.
Among 58 patients enrolled, 27 patients (46.6%) were complicated by superimposed HCC, while 31 patients (53.4%) were CLD patients without superimposed HCC. The sensitivity and specificity of serum ALT level below 87 JU/L (×3 of upper normal
limit)
for
the detection of HCC were 85.2% and 80.6%, respectively. Out of 31 CLD patients uncomplicated by HCC, the subsequent AFP levels in 24 decreased in a month by 50%. In contrast, 10 CLD patients complicated by HCC whose subsequent serum AFP levels
were
checked, showed elevation or no-chaange of AFP levels, but not decreased at all in a month. We conclude that more than half of the CLD patients with serum AFP above 400 ng/ml and no mass lesion in the liver on ultrasonogram had not been
complicated
by
HCC, and the initial ALT level and the subsequent serum AFP in 2~4 weeks will be useful as simple and noninvasive exclusion diagnostic tool for the differentiation of CLD complicated by HCC.
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