The Utility of Lens Culinaris Agglutinin-Reactive α-Fetoprotein in the Diagnosis of Hepatocellular Carcinoma: Evaluation in a United States Referral Population  Apinya Leerapun, Sri V. Suravarapu, John P. Bida, Raynell J. Clark, Elizabeth L. Sanders, Teresa A. Mettler, Linda M. Stadheim, Ileana Aderca, Catherine D. Moser, David M. Nagorney, Nicholas F. LaRusso, Piet C. de Groen, K.V. Narayanan Menon, Konstantinos N. Lazaridis, Gregory J. Gores, Michael R. Charlton, Rosebud O. Roberts, Terry M. Therneau, Jerry A. Katzmann, Lewis R. Roberts  Clinical Gastroenterology and Hepatology  Volume 5, Issue 3, Pages 394-402 (March 2007) DOI: 10.1016/j.cgh.2006.12.005 Copyright © 2007 AGA Institute Terms and Conditions

Figure 1 (A) ROC curves comparing the total AFP level with AFP-L3% for the diagnosis of HCC in individuals with a total AFP level of greater than 10 ng/mL. (B) ROC curves comparing the total AFP level with AFP-L3% for the diagnosis of HCC in individuals with a total AFP level between 10 and 200 ng/mL. Clinical Gastroenterology and Hepatology 2007 5, 394-402DOI: (10.1016/j.cgh.2006.12.005) Copyright © 2007 AGA Institute Terms and Conditions

Figure 2 Scatter plot of AFP-L3% by AFP category. For individuals with a total AFP level in the indeterminate range of 10–200 ng/mL, an AFP-L3% level of greater than 35% was 100% specific, with no false positives. The curved line represents an absolute AFP-L3 cut-off value of 11 ng/mL, which was also 100% specific. NR, AFP-L3 values are nonspecific and not reported when the total AFP value is 0.8–10 ng/mL and the AFP-L3 is greater than 0.5%. •, HCC; ▵, CLD; ▿, benign. Clinical Gastroenterology and Hepatology 2007 5, 394-402DOI: (10.1016/j.cgh.2006.12.005) Copyright © 2007 AGA Institute Terms and Conditions

Figure 3 Distribution of AFP-L3 level by tumor characteristics. Histograms showing the relationship between AFP-L3% and tumor characteristics: (A) tumor size, (B) tumor stage, (C) vascular invasion, and (D) histologic grade. The means were calculated without taking into consideration AFP-L3 values that were not detected (ND), not reported (NR), not measurable because the total AFP level was undetected (U), or not measurable because the total AFP level was greater than 300,000 ng/mL high (H). There is little effect of L3% for tumor size, tumor grade, and vascular involvement. There is a possible trend for association of L3% with TNM, but the numbers are small. Clinical Gastroenterology and Hepatology 2007 5, 394-402DOI: (10.1016/j.cgh.2006.12.005) Copyright © 2007 AGA Institute Terms and Conditions

Figure 3 Distribution of AFP-L3 level by tumor characteristics. Histograms showing the relationship between AFP-L3% and tumor characteristics: (A) tumor size, (B) tumor stage, (C) vascular invasion, and (D) histologic grade. The means were calculated without taking into consideration AFP-L3 values that were not detected (ND), not reported (NR), not measurable because the total AFP level was undetected (U), or not measurable because the total AFP level was greater than 300,000 ng/mL high (H). There is little effect of L3% for tumor size, tumor grade, and vascular involvement. There is a possible trend for association of L3% with TNM, but the numbers are small. Clinical Gastroenterology and Hepatology 2007 5, 394-402DOI: (10.1016/j.cgh.2006.12.005) Copyright © 2007 AGA Institute Terms and Conditions

Figure 4 Survival in HCC patients by AFP-L3% level and total AFP level. (A) An AFP-L3% level of greater than 10% predicts survival of patients with HCC (P = .0012). (B) A total AFP level of greater than 200 ng/mL is a better predictor of survival of HCC patients (P < .0001). Once the total AFP level is taken into account, there is no additional prognostic value of the AFP-L3% in this cohort. Clinical Gastroenterology and Hepatology 2007 5, 394-402DOI: (10.1016/j.cgh.2006.12.005) Copyright © 2007 AGA Institute Terms and Conditions