Diagnostic value of serum ferritin in primary hepatocellular carcinoma

The diagnostic value of serum ferritin levels was evaluated in 19 patients with biopsy-proven primary hepatocellular carcinoma (PHC) and 26 patients with chronic liver disease (CLD). Serum ferritin levels were significantly elevated in PHC, as compared with CLD and controls (p less than 0.0005). Similarly, serum ferritin/SGOT ratio, an index of increased ferritin production, was significantly higher in PHC than in CLD and controls. Serum alpha-fetoprotein (alpha-FP) was higher in PHC than in CLD (p less than 0.0025). No significant correlation was noted between serum ferritin and alpha-fetoprotein or SGOT in PHC and CLD. 17 of 19 patients with PHC had serum ferritin values over 450 ng/ml (sensitivity 88%). By contrast, only 10 of 17 patients with PHC (59%) demonstrated alpha-FP levels over 25 ng/ml, compatible with the diagnosis of PHC. 9 of these 10 patients had ferritin levels over 450 ng/ml, within the distribution of values for PHC. Conversely, 7 of 17 patients with PHC (40%) had normal levels of alpha-FP (false-negative). However, 6 of these patients (86%) had ferritin levels over 450 ng/ml, consistent with values in PHC. In this study, the overall sensitivity of serum ferritin in PHC was higher than that of alpha-FP (88 versus 59%) and its specificity 85 versus 68% for alpha-FP. These data indicate that serum ferritin may be utilized as a useful diagnostic marker in the evaluation of patients with PHC.