Combined α fetoprotein testing and ultrasonography as a screening test for primary liver cancer
Combined α fetoprotein testing and ultrasonography as a screening test for primary liver cancer
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DOI：
10.1136/jms.6.2.108
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发表时间：
1999-01-01
影响因子：
2.9
通讯作者：
Yang, BH
中科院分区：
文献类型：
--
作者：
Zhang, BH;Yang, BH
目的：评价血清甲胎蛋白检测与超声联合筛查原发性肝癌的有效性和成本。方法对9373例35~59岁乙肝表面抗原(HBs)阳性或慢性肝炎患者进行研究。结果指标为发现率、假阳性率和阳性预测值、每发现一例原发性肝癌的成本，以及通过联合方法检测每一例新增原发性肝癌的平均成本。用检出的小肝癌数进行经济评价。结果共筛查20294次。在51名受试者中发现了原发性肝癌，其中36人患有小的原发性肝癌。胎儿蛋白与超声同时检测时，其阳性诊断率为92%，假阳性率为7.5%，阳性预测值为3.0%，每检出一例原发性肝癌的成本为30206元(人民币，3639美元)。单项超声检查的阳性诊断率为84%，假阳性率为2.9%，阳性预测值为6.6%，每检出一例原发性肝癌的成本为16451元(1982美元)。甲胎蛋白联合检测的检出率、假阳性率和阳性预测值分别为69%、5.0%和3.3%，每检出一例原发性肝癌的成本为25139元(3029美元)。在中国经济发达地区，联合检查可能是筛查原发性肝癌的最佳选择，但在其他方面，单独使用超声检查是首选方法。
Objective-To assess the validity and cost of a screening test for primary liver cancer using combined serum a fetoprotein testing and ultrasonography.Setting-An urban community in Shanghai, China.Methods-9373 subjects aged 35 to 59 with positive hepatitis B surface antigen (HBsAg) or chronic hepatitis were studied. Outcome measures were detection rate, false positive rate, and positive predictive value, the cost for each primary liver cancer detected, and the average cost of detecting each additional primary liver cancer by the combined method. The number of small primary liver cancers detected was used for the economic evaluation.Results-20 294 screening examinations were carried out. Primary liver cancer was detected in 51 subjects, 36 of whom had small primary liver cancer. When a fetoprotein and ultrasonography were used in parallel the detection rate, false positive rate, and positive predictive value were 92%, 7.5%, and 3.0%, respectively; the cost for each primary liver cancer detected was 30 206 RMB (Chinese currency, $3639). When ultrasonography was used alone the detection rate, false positive rate, and positive predictive value were 84%, 2.9%, and 6.6%, respectively; the cost for each primary liver cancer detected was 16 451 RMB ($1982). When the a fetoprotein test was used alone the detection rate, false positive rate, and positive predictive value were 69%, 5.0%, and 3.3%, respectively; the cost for each primary liver cancer detected was 25 139 RMB ($3029).Conclusion-The combination of both screening methods results in a relatively small increase in detection but a considerably higher false positive rate, increasing the costs. The combined test may be the best choice for primary liver cancer screening in developed areas of China, but otherwise, ultrasonography alone is the method of choice.