Accuracy of the preoperative determination of tumor markers in the differentiation of liver mass lesions in surgical patients

Background/Aims: The diagnostic accuracy of tumor markers for differentiating focal liver lesions is not yet defined. Therefore, we carried out a retrospective analysis to address this issue. Methodology: We retrospectively evaluated 192 consecutive patients with 289 focal liver lesions. The serum levels of AFP, PIVKA II, CEA, and CA19-9 were determined in 119 patients, while at least one of these values was lacking in the others. All patients underwent liver resection: 136 patients had hepatocellular carcinoma, 39 metastases, 9 cholangiocarcinoma, 1 mixed hepatocellular carcinoma-cholangiocarcinoma, and 7 benign lesions. Results: At least one of the tumor markers examined was elevated in 169 of the 185 patients with proven malignancy. In 92 cases, the elevation was marked. The mean levels of each tumor marker were significantly different among patients grouped according to the tumor type. ROC curves showed that 10ng/mL was the optimal cut-off level for AFP and hepatocellular carcinoma, and for CEA and colorectal liver metastases. CEA and CA 19-9 showed specific patterns of elevation in liver metastases and cholangiocarcinoma. Conclusions: Common tumor markers for focal liver lesions were significantly linked to the type of the tumor. These findings suggest that their selective estimation may be useful for the preoperative diagnosis of focal liver lesions.