Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis (683 page)

   Hereditary tyrosinemia

   Primary hepatocellular carcinoma

   Teratocarcinoma

   Gastrointestinal tract cancers with and without liver metastases

   Benign hepatic conditions such as acute viral hepatitis, chronic active hepatitis, and cirrhosis

   Limitations

   AFP is not recommended as a screening procedure to detect cancer in the general population. This assay is intended only as an adjunct in the diagnosis and monitoring of AFP-producing tumors. The diagnosis should be confirmed by other tests or procedures.

   Serum levels of AFP do not correlate well with other clinical features of HCC, such as size, stage, or prognosis.

   A case–control study evaluated the diagnostic characteristics of the serum AFP in screening for HCC in patients with different types of chronic liver disease. The following sensitivities and specificities were observed:

   AFP cutoff 16 μg/L (sensitivity 62%, specificity 89%)

   AFP cutoff 20 μg/L (sensitivity 60%, specificity 91%)

   AFP cutoff 100 μg/L (sensitivity 31%, specificity 99%)

   AFP cutoff 200 μg/L (sensitivity 22%, specificity 99%)