Ultrasonographic and radionuclide detection of hepatocellular carcinoma in cirrhotics with low alpha-fetoprotein levels

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Abstract
A total of 67 cirrhotic patients with clinically suspected neoplastic degeneration and low alpha‐fetoprotein levels were assessed prospectively with ultrasound and gold (198Au) scintigraphy. Ultrasound showed space‐occupying lesions in 22 of the 24 patients who had a final diagnosis of hepatocellular carcinoma (HCC) (sensitivity, 95.8%) and excluded the presence of HCC in 37 of the 43 patients with cirrhosis only (specificity, 86.0%; efficiency, 90.8%). Scintigraphy demonstrated a cold defect in 22 of the 24 patients who had a final diagnosis of HCC (sensitivity, 95.8%) and excluded the presence of HCC in 22 of the 43 patients with cirrhosis only (specificity, 51.1%; efficiency, 69.8%). It was concluded that the most accurate screening plain in cirrhotic patients suspected of having HCC with alpha‐fetoprotein values below 500 mg/ml would consist of ultrasonography followed, as clinically indicated, by ultrasonographic or laparoscopic guided biopsy.