Evaluation of alpha-fetoprotein assay in ascitic fluid for the diagnosis of hepatocellular carcinoma

Ascites and hepatocellular carcinoma are frequently associated. We evaluate d the usefulness of alpha-fetoprotein assay in ascitic fluid versus the ser um assay, for the diagnosis of hepatocellular carcinoma, in 125 patients wi th peritoneal effusions (31 patients with hepatocellular carcinoma, 14 with extra-hepatic malignancies and 80 with a benign effusion). Albumin and tot al protein were also assayed and cytological analysis of the ascitic fluid performed. Alpha-fetoprotein appeared to be lower in ascitic fluid than in serum. For a diagnostic specificity of 95%, the thresholds were 18.9 mu g/l in serum and 4 mu g/l in ascitic fluid and the diagnostic sensitivity of a lpha-fetoprotein was identical in serum and ascitic fluid (67.7%). Various ratios between alpha-fetoprotein and albumin or total protein did not enhan ce the diagnostic performance. Thus alpha-fetoprotein concentration in asci tic fluid reflected the serum concentration and proved to be of similar val ue for the diagnosis of hepatocellular carcinoma, providing that the approp riate thresholds are considered. (C) 1999 Elsevier Science B.V. All rights reserved.