α-fetoprotein and ultrasonography screening for hepatocellular carcinoma
α-fetoprotein and ultrasonography screening for hepatocellular carcinoma
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DOI：
10.1053/j.gastro.2004.09.023
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发表时间：
2004-11-01
期刊：
影响因子：
29.4
通讯作者：
Tinessa, V
中科院分区：
文献类型：
--
作者：
Daniele, B;Bencivenga, A;Tinessa, V
虽然没有确切的证据表明，在高危人群中进行肝细胞癌（HCC）筛查可以提高生存率，但许多医生采用各种策略对高危人群进行筛查。甲胎蛋白（AFP）和肝脏超声检查（US）是最广泛使用的工具。AFP的敏感性和特异性取决于所选择的截止值。在肝硬化患者中，使用20 ng/mL的截止水平，灵敏度仅为60%左右，阳性预测值范围为9%至50%，具体取决于HCC的患病率。B型肝炎携带者的敏感性和特异性更高（分别为94.1%和99.9%），但阳性预测值仅为5%。超声作为筛查工具的表现因检查者的经验和使用的技术而异。最近的研究通常表明60%或更高的灵敏度，特异性大于90%，阳性预测值为70%。使用AFP、US或两者的筛查策略的成本效益已经被回顾性地或使用决策模型进行了估计。一般来说，使用AFP和US进行HCC筛查似乎具有边缘成本效益或根本不具有成本效益。根据估计的HCC倍增时间，推荐的筛查间隔为6个月，尽管1年的间隔似乎也有效。目前，不推荐仅使用AFP进行HCC筛查，除非US不可用或质量较差。US作为筛查工具似乎更有效。活体肝移植中肝移植物的病理学评估将为AFP和US作为HCC筛查工具的价值提供更精确和可靠的信息。
Although there is no definitive evidence that hepatocellular carcinoma (HCC) screening in high-risk groups improves survival, many physicians screen high-risk populations with various strategies. alpha-fetoprotein (AFP) and liver ultrasonography (US) are the most widely used tools. AFP sensitivity and specificity depend on the cutoff value chosen. In cirrhotic patients, using a cut-off level of 20 ng/mL, sensitivity is only around 60% and positive predictive value ranges from 9% to 50%, depending on HCC prevalence. Sensitivity and specificity are much higher (94.1% and 99.9%, respectively) in hepatitis B carriers, but positive predictive value is only 5%. The performance of US as a screening tool varies widely depending on the experience of the examiner and the technology used. Recent studies generally indicate a 60% sensitivity or higher, a specificity greater than 90%, and a positive predictive value of 70%. The cost effectiveness of screening strategies using AFP, US, or both have been estimated retrospectively or using decision models. In general, HCC screening using both AFP and US appears to be of borderline cost effectiveness or not cost effective at all. Based on the estimated HCC doubling time, the recommended screening interval is 6 months, although a 1-year interval seems as effective. Currently, HCC screening with AFP only is not recommended except when US is either not available or of poor quality. US seems more efficient as a screening tool. Pathology assessment of liver explants in living-donor transplantation programs will provide more precise and reliable information regarding the value of AFP and US as HCC screening tools.