Evaluation of Serum Total Bile Acids in the Diagnosis of Hepatocellular Carcinoma

Fasting total serum bile acids (FSBA) concentrations were measured in 140 cases of chronic liver diseases including 50 patients with liver cirrhosis, 40 patients with chronic hepatitis and 50 patients with hepatocellular carcinoma (HCC). FSBA concentrations were significantly higher in patients with HCC than those with chronic hepatitis and cirrhosis and both were significantly higher than the controls (p < 0.0001). FSBA concentrations were not correlated to the size of the tumor, the Child Pugh grades, the histopathologic grades and most of the liver function tests. Using the receiver operative characteristic (ROC) and the differential positive rate (DPR) analysis, 30 µmol/l was the optimal cut-off value that differentiates patients with HCC from those with cirrhosis. At this level, the sensitivity, the specificity and the diagnostic accuracy were 42%, 98% and 70% respectively. AFP was found to be significantly increased in patients with HCC than those with chronic hepatitis and cirrhosis. The best cut-off value of AFP was 100 ng/ml, at which the sensitivity, the specificity and diagnostic accuracy were 52%, 96% and 74% respectively. The simultaneous determination of AFP and total bile acids raised the sensitivity of the test to 76%. The area under the ROC curve for AFP and total bile acids was 0.764 and 0.744 respectively, the difference is nonsignificant. In conclusion, both AFP and total bile acids are good markers for HCC and their simultaneous determination may improve the detection of HCC in cirrhotic patients negative for AFP.