Test characteristics of alpha-fetoprotein for detecting hepatocellular carcinoma in patients with hepatitis C: a systematic review and critical analysis

Article Abstract:

Background: Patients with hepatitis C virus (HCV) are at increased risk for hepatocellular carcinoma. Although serum alpha-fetoprotein (AFP) is often used to detect hepatocellular carcinoma in HCV-infected individuals, its utility is unclear. Purpose: To define the test characteristics of AFP for the diagnosis of hepatocellular carcinoma in patients with HCV. Data Sources: MEDLINE search from 1966 to December 2002 for English- and non-English-language articles examining the test characteristics of AFP for identifying hepatocellular carcinoma. Study Selection: Articles were included if they reported the sensitivity and specificity of AFP for detecting hepatocellular carcinoma in patients with HCV. Articles were excluded if the cause of hepatitis was ambiguous or if 50% or more of the study patients did not have HCV. Data Extraction: Relevant articles were evaluated for quality of evidence; test characteristics were abstracted and calculated. Data Synthesis: Five studies met all inclusion criteria and were analyzed. The overall quality of evidence was limited; only one study universally applied an acceptable gold standard test, and three of five studies used a case-control design that potentially overestimates diagnostic accuracy. By using the most commonly reported cutoff value of a positive test result for hepatocellular carcinoma (AFP level > 20 micrograms/L), the ranges of test characteristics were as follows: sensitivity, 41% to 65%; specificity, 80% to 94%; positive likelihood ratios, 3.1 to 6.8; and negative likelihood ratios, 0.4 to 0.6. Conclusions: The paucity of high-quality data calls for more rigorous study of AFP and other diagnostic tests for detecting hepatocellular carcinoma in HCV-infected patients with an accepted gold standard applied to the entire cohort. Even if the "best-case" estimates of AFP sensitivity and specificity are accurate, AFP has limited utility for detecting hepatocellular carcinoma.

Alpha fetoproteins, Author Abstract

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Relation of interferon therapy and hepatocellular carcinoma in patients with chronic hepatitis C

Article Abstract:

The use of interferon therapy seems to lower the risk of liver cancer in people with hepatitis C. Interferon therapy was used for 419 patients with chronic hepatitis C, and the results compared against the historical liver biopsy records of 144 patients who also had chronic hepatitis C but did not receive interferon therapy. In comparing the two groups, there was a noticeably lower incidence of liver cancer in the group receiving interferon therapy.

Interferon

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Does this adult patient have septic arthritis?

Article Abstract:

The accuracy and precision of the clinical evaluation for the diagnosis of nongonococcal bacterial arthritis is reviewed based on different case studies. Clinical findings have identified patients with peripheral, monoarticular arthritis who might have septic arthritis.

United States, Arthritis, Infectious, Infectious arthritis, Aged patients, Elderly patients, Clinical report

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