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Original ArticleOpen Access
Clinical Utility of Lens Culinaris Agglutinin-Reactive Alpha-Fetoprotein in the Diagnosis of Hepatocellular Carcinoma: Evaluation in a Thai Referral Population
Tanwandee T 
,
Setthasin S ,
Charatcharoenwitthaya P ,
Chainuvati S ,
Leelakusolvong S ,
Pausawasdi N ,
Srikureja W ,
Pongprasobchai S ,
Manatsathit S ,
Kachintorn U ,
Ekpo P ,
Senawong S
,
Setthasin S ,
Charatcharoenwitthaya P ,
Chainuvati S ,
Leelakusolvong S ,
Pausawasdi N ,
Srikureja W ,
Pongprasobchai S ,
Manatsathit S ,
Kachintorn U ,
Ekpo P ,
Senawong S Background and Objective: There is no established clinical role for the lens culinaris agglutinin-reactive
fraction of alpha-fetoprotein (AFP-L3%) in the management of the Thai hepatocellular carcinoma (HCC)
patient population. The aim of this prospective study was to evaluate clinical utility and performance
characteristics of AFP-L3% for the diagnosis of HCC in Thai referral patients.
Material and Method: Sixty-one histologically proven HCC patients and 35 patients with other liver cancers
were included for analysis.
Results: The HCC population was comprised of 50 males and 11 females, with a mean age of 48.8 years.
According to the Okuda system, three were classed as stage I, thirty-five belonged to stages II, and six were
classified in stage III. An AFP-L3% a cut-off value of > 15% yielded a sensitivity of 82% (95% confidence
interval [CI], 74-88%), specificity of 71% (95% CI, 58-82%), positive predictive value of 83% (95% CI, 75-90),
and negative predictive value of 69% (95% CI, 56-80) for the diagnosis of HCC. In HCC patients with AFP of
< 200 ng/ml, an AFP-L3% at a cut-off value of > 15% not only maintained high sensitivity of 83% and good
specificity of 71% but also increased negative predictive value to 86% for the diagnosis of HCC.
Conclusion : AFP-L3% provides high sensitivity but with lower sensitivity in the diagnosis of HCC than total
AFP in individuals with symptomatic liver mass. However, considering its high negative predictive value in
patients with AFP < 200 ng/ml, AFP-L3% might be useful as an adjunctive marker, in combination with AFP,
to exclude the presence of HCC.
Keywords: Alpha-fetoprotein, Hepatocellular carcinoma, Hepatitis B virus, Len culinaris
fraction of alpha-fetoprotein (AFP-L3%) in the management of the Thai hepatocellular carcinoma (HCC)
patient population. The aim of this prospective study was to evaluate clinical utility and performance
characteristics of AFP-L3% for the diagnosis of HCC in Thai referral patients.
Material and Method: Sixty-one histologically proven HCC patients and 35 patients with other liver cancers
were included for analysis.
Results: The HCC population was comprised of 50 males and 11 females, with a mean age of 48.8 years.
According to the Okuda system, three were classed as stage I, thirty-five belonged to stages II, and six were
classified in stage III. An AFP-L3% a cut-off value of > 15% yielded a sensitivity of 82% (95% confidence
interval [CI], 74-88%), specificity of 71% (95% CI, 58-82%), positive predictive value of 83% (95% CI, 75-90),
and negative predictive value of 69% (95% CI, 56-80) for the diagnosis of HCC. In HCC patients with AFP of
< 200 ng/ml, an AFP-L3% at a cut-off value of > 15% not only maintained high sensitivity of 83% and good
specificity of 71% but also increased negative predictive value to 86% for the diagnosis of HCC.
Conclusion : AFP-L3% provides high sensitivity but with lower sensitivity in the diagnosis of HCC than total
AFP in individuals with symptomatic liver mass. However, considering its high negative predictive value in
patients with AFP < 200 ng/ml, AFP-L3% might be useful as an adjunctive marker, in combination with AFP,
to exclude the presence of HCC.
Keywords: Alpha-fetoprotein, Hepatocellular carcinoma, Hepatitis B virus, Len culinaris
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