Abstract
Clinical Scenario A 63-year-old man with hepatitis C virus– induced cirrhosis is referred to the clinic for evaluation of an increase in the level of alpha-fetoprotein (AFP) to 400 ng/mL, which was detected in a blood test performed by the primary care physician. The patient is active at work and asymptomatic. He has compensated cirrhosis and well-preserved liver function, with a serum albumin level of 38 g/L, a serum bilirubin level of 1.6 mg/dL, and a prothrombin time of 1.2 international normalized ratio. Physical examination shows a liver span of 4 cm and splenomegaly without ascites. The ultrasound examination shows hepatomegaly without any liver mass, preserved portal blood flow, and splenomegaly. What should be the diagnostic strategy for this patient? What is the role of monitoring AFP levels as a surveillance strategy for detection of hepatocellular carcinoma (HCC), or as a biomarker for diagnosis of HCC? What is the accuracy of ultrasonography, computed tomography (CT) scan, and magnetic resonance imaging (MRI) in the detection and staging of HCC?
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