The use of AFP measurement alone as a screening tool has been successful in detecting early treatable tumours in populations with a high prevalence and incidence of HCC such as Asia and Sub-Saharan Africa.28,40,41 However, the screening for HCC with AFP alone in populations with a lower incidence of HCC is associated with very low predictive values.42,43 Trials in China have shown that the combination of US and AFP is better than either alone for the screening of HBsAg positive subjects; otherwise, US alone is the method of choice since it is better than AFP.44,45
The superiority of US to AFP was further demonstrated in a 7-year prospective surveillance study to determine the optimal test for detection of early HCC. It studied both AFP and US and concluded that US examination was more accurate than AFP. Thirty-one cases of HCC were detected in 602 patients with chronic viral hepatitis; the positive predictive value (PPV) for AFP to detect HCC was only 12% or less for all AFP cut-off values, and the maximum joint sensitivity and specificity were approximately 65 and 90%, respectively. Abdominal US on the other hand identified all 31 cases of HCC. The PPV for US examinations to detect HCC was 78%, while the sensitivity and specificity were 100 and 98%, respectively.45
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