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-Fetoprotein Levels
1 Department of Clinical Oncology, The Chinese University of Hong Kong, Hong
Kong, China.
2 Department of Diagnostic Radiology & Organ Imaging, Prince of Wales
Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing St., Sha Tin,
N.T., Hong Kong, China.
3 Department of Medicine and Therapeutics, The Chinese University of Hong Kong,
Hong Kong, China.
4 Department of Surgery, The Chinese University of Hong Kong, Hong Kong,
China.
OBJECTIVE. Routine screening for hepatocellular carcinoma among
chronic carriers of hepatitis B virus using a combination of abdominal
sonography and serum 
-fetoprotein levels is widely practiced. Negative
results on an abdominal sonogram generally indicate the absence of
hepatocellular carcinoma despite the elevation of -fetoprotein levels,
but the false-negative rate of abdominal sonography has not been established
prospectively.
SUBJECTS AND METHODS. In our screening program, we routinely
investigated patients with Lipiodol (iodized oil) CT when they presented with
-fetoprotein levels above 20 ng/mL or a focal lesion as depicted on
abdominal sonography. Lipiodol CT comprised a hepatic angiogram with injection
of Lipiodol selectively in the hepatic arteries, followed by an unenhanced CT
scan 10 days later. Positive findings on Lipiodol CT were confirmed
histologically by biopsy or surgical resection. We defined false-negative as
histologic diagnosis of hepatocellular carcinoma within 3 months of normal
findings on screening abdominal sonography.
RESULTS. One hundred three patients with elevated
-fetoprotein levels were investigated with Lipiodol CT within 2 months
of abdominal sonography. Of these, three of 70 patients with negative
abdominal sonography had histologically confirmed hepatocellular carcinoma.
Thus, abdominal sonography has a false-negative rate of 4.3%. Lipiodol CT is
associated with a significant false-positive rate of 43.7%. The sensitivity,
specificity, and positive predictive value of abdominal sonography for early
detection of hepatocellular carcinoma among hepatitis B virus carriers with
elevated -fetoprotein levels was 85.7%, 81.7%, and 54.5%,
respectively.
CONCLUSION. Negative results on a screening abdominal sonogram among
hepatitis B virus carriers with elevated -fetoprotein levels does not
rule out the presence of small hepatocellular carcinoma. Routine use of
Lipiodol CT as a supplementary screening tool is not recommended.
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