## Discriminating HCC from Benign Cirrhotic Nodules **Key Point:** AFP >400 ng/mL in the setting of imaging-confirmed nodule is highly specific (>95%) for HCC and is part of diagnostic criteria (AASLD/EASL guidelines). | Marker | HCC Specificity | Benign Cirrhosis | Clinical Use | |--------|-----------------|------------------|---------------| | **AFP >400 ng/mL** | >95% | Rarely elevated | Diagnostic criterion | | **CEA** | Low specificity | Non-specific | Not HCC-specific | | **ALP elevation** | Non-specific | Common in cirrhosis | Reflects cholestasis | | **APRI score** | Reflects fibrosis | Elevated in cirrhosis | Prognostic, not diagnostic | **High-Yield:** AFP levels correlate with tumor burden and differentiation. Rapid rise (doubling time <20 days) suggests aggressive HCC. However, AFP alone cannot diagnose HCC; imaging (CT/MRI) confirmation is mandatory. **Clinical Pearl:** In nodules 1–2 cm, AFP >400 ng/mL increases confidence in HCC diagnosis; in nodules >2 cm, typical imaging appearance (arterial enhancement + washout) suffices without AFP.
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