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Combining Ultrasound Imaging With Alpha-Fetoprotein Test May Boost Detection of Hepatocellular Carcinoma

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Key Points

  • Adding assessment of the blood biomarker alpha fetoprotein increased detection of early-stage hepatocellular carcinoma from 45% with ultrasound alone to 63% using the two tests in combination.
  • Alpha fetoprotein is a plasma protein that is produced in abundance by the liver cells in the fetus. In adults, levels of this biomarker are normally low, but liver cancer can cause these levels to rise.  

Combining ultrasound imaging with a blood test for high alpha fetoprotein levels may improve detection of early-stage liver cancer by as much as 40%, researchers at UT Southwestern’s Simmons Cancer Center found. Their findings were presented by Tzartzeva et al in Gastroenterology.

Earlier detection is important to improving the survival of patients with liver cancer, which is the fastest increasing solid tumor cancer in the United States, according to the National Cancer Institute (NCI).

“If the cancer is found early, then we can perform curative therapies, allowing patients to live for many years,” said hepatologist Amit Singal, MD, MS, Associate Professor of Internal Medicine and Clinical Sciences at Simmons. “Unfortunately, most liver cancer in the United States is discovered at later stages, when curative treatment is not possible and survival is much worse.”

While the incidence of most cancers is decreasing in the United States, the incidence of liver cancer has increased by 2.7% per year over the past 10 years, according to the NCI, which estimated about 40,700 new cases of liver cancer will be diagnosed in the United States in 2018.

Screening Guidelines

Liver cancer screening guidelines for patients with cirrhosis vary, with some guidelines calling for just imaging and other guidelines calling for both imaging and alpha fetoprotein measurement. Liver cancer screening in patients with chronic liver disease has traditionally been performed using an abdominal ultrasound. While ultrasound is readily available and noninvasive, “it misses many cancers when they are small,” said Dr. Singal, who also holds the David Bruton, Jr Professorship in Clinical Cancer Research and is the Dedman Family Scholar in Clinical Care at UT Southwestern. “Our study found that adding the blood biomarker alpha fetoprotein increased detection of early-stage hepatocellular carcinoma from 45% with ultrasound alone to 63% using the two tests in combination.”

Alpha fetoprotein is a plasma protein that is produced in abundance by liver cells in the fetus. In adults, alpha fetoprotein levels are normally low, but liver cancer can cause these levels to rise.  

“Our results highlight the importance of continued development and validation of blood-based biomarkers for [early detection of] liver cancer. Most important, our results support a change in clinical practice and the routine use of ultrasound and biomarkers together for liver cancer screening,” said Dr. Singal.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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