The diagnostic problems in Hepatocellular Carcinoma and the relevance of Alpha-feto protein and aspiration cytology biopsy

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University of Dar es Salaam
Fifty seven patients with suspicion of liver malignancy were evaluated at Muhimbili Medical Centre medical wards. Of the 49 in whom definitive diagnosis could be reached 27 had Hepatocellular Carcinoma (HCC). Liver Cirrhosis and liver abscess were present in seven each whilst chronic hepatitis, Tropical splenomegaly syndrome, nonspecific granulomatous lesion and liver metastasis were present in two each. Thus 29 patients out of the 49 initially suspected of malignancy in whom diagnoses were available, had malignancy, a clinical predictability of 59.2%. Clinical assessment and routine investigation given only scanty information for differentiating one disease entity from another. Serum Alpha-feto Protein (AFP) by Double diffusion I agar (DDIA) method could detect only 10 out of 23 (43.5%) patients with Hepatocellular carcinoma in which this method could be used. This test is very specific as there were no false positive but is less sensitive as 13 HCC patients were missed. It is suggested that this could be remedied to some extent by ‘topping up’, a slight modification of the method which is common use. By Radio- immunoassay (RIA) method, AFP was above 20ng/ml in 15 out of 19(78.9%) HCC patient in whom this test could be done. There was one false positive in a patient with micro nodular cirrhosis. It is a moderately sensitive but less specific test. The RIA method is complicated and probably unsuitable for our hospitals. In the 40 patients were cytology, histology and AFP by RIA method were available, aspiration cytology biopsy had an overall accuracy of 87.5%. specificity was 93.8% and sensitivity was 83.3%. since diagnostic ascertainment by blind liver biopsy and AFP above 500ng/ml were not optimal they could account for some of the false positives and false negative. A aspiration cytology biopsy was found to be a simple and easy procedure with minimum discomfort to the patient. It has been recommended that it could be used several times in the same patient. This our increase the yield and decrease the number of false negatives. In our experience the aspiration technique was instrumental in the diagnosis of 7 patients with liver abscess. Serum Alpha-feto protein by DDIA method and aspiration cytology biopsy are simple diagnostic methods which could be uded even un our rural hospital setting to reach a diagnosis of malignant liver disease. The methods and their applicability needs to be evaluated further.
Available in print form, East Africana Collection, Dr.Wilbert Chagula Library, class mark (THS EAF RC848.A2.Y9)
Hepatitis, Infectious, Liver malignancy, Liver abseess, Amebia
Yusufali, A.M (1982) The diagnostic problems in Hepatocellular Carcinoma and the relevance of Alpha-feto protein and aspiration cytology biopsy, Masters dissertation, University of Dar es Salaam, Dar es Salaam.