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α-Fetoprotein (AFP), Tumor Marker

CPT: 82105
Updated on 12/9/2019
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Synonyms

  • AFP, Serum
  • Alpha-Fetoprotein (AFP), Serum, Tumor Marker

Special Instructions

If patient is pregnant, include approximate gestational age on the test request form and order test 010801. Values obtained with different assay methodologies should not be used interchangeably in serial testing. It is recommended that only one assay method be used consistently to monitor a patient's course of therapy. This procedure does not provide serial monitoring; it is intended for one-time use only. If serial monitoring is required, please use the serial monitoring number 480012 to order.

This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample.

If patient is pregnant, include approximate gestational age on the test request form and order test 010801. Values obtained with different assay methodologies should not be used interchangeably in serial testing. It is recommended that only one assay method be used consistently to monitor a patient's course of therapy. This procedure does not provide serial monitoring; it is intended for one-time use only. If serial monitoring is required, please use the serial monitoring number 480012 to order.

This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample.

If patient is pregnant, include approximate gestational age on the test request form and order test 010801. Values obtained with different assay methodologies should not be used interchangeably in serial testing. It is recommended that only one assay method be used consistently to monitor a patient's course of therapy. This procedure does not provide serial monitoring; it is intended for one-time use only. If serial monitoring is required, please use the serial monitoring number 480012 to order.

This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample.


Expected Turnaround Time

Within 1 day



Related Documents


Specimen Requirements


Specimen

Serum


Volume

0.8 mL


Minimum Volume

0.3 mL (Note: This volume does not allow for repeat testing.)


Container

Red-top tube or gel-barrier tube


Collection

If a red-top tube is used, transfer separated serum to a plastic transport tube.


Storage Instructions

Room temperature


Stability Requirements

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3


Causes for Rejection

Citrate plasma specimen; improper labeling


Test Details


Use

The most important application of AFP testing in cancer management is for testicular cancer. Although not present in pure seminoma,1 elevated serum AFP is closely associated with nonseminomatous testicular cancer.2-4 The measurement of AFP in serum, in conjunction with serum hCG, is an established regimen for monitoring patients with nonseminomatous testicular cancer.5-8 In addition, monitoring the rate of AFP clearance from serum after treatment is an indicator of the effectiveness of therapy.9,10 Conversely, the growth rate of progressive cancer can be monitored by serially measuring serum AFP concentration over time.11 Serial serum AFP testing is a useful adjunctive test for managing nonseminomatous testicular cancer.


Limitations

The measured AFP value of a patient's sample can vary depending on the test procedure used. The laboratory finding must, therefore, always contain a statement on the AFP assay method used. AFP values determined on patient samples by different test procedures cannot be directly compared with one another and could be the cause of erroneous medical interpretations.

As with all tests containing monoclonal mouse antibodies, erroneous findings may be obtained from samples taken from patients who have been treated with monoclonal mouse antibodies or who have received them for diagnostic purposes.12 In rare cases, interference due to extremely high titers of antibodies to streptavidin and ruthenium can occur.12 The test contains additives, which minimize these effects.

For diagnostic purposes, the results should always be assessed in conjunction with the patient's medical history, clinical examination, and other findings.


Methodology

Electrochemiluminescence immunoassay (ECLIA)


Reference Interval

Tumor marker normals: 0.0−8.3 ng/mL. Normal values apply only to males and to nonpregnant females. These results are not interpretable for pregnant females.


Additional Information

The Elecsys AFP assay is intended for the in vitro quantitative determination of α1-fetoprotein in human serum and plasma to aid in the management of patients with nonseminomatous germ cell tumors.12 The determination of AFP to screen the general population for cancer is, however, not to be recommended.

A1-fetoprotein, an albumin-like glycoprotein with a molecular weight of 70,000 daltons, is formed in the yolk sac, nondifferentiated liver cells, and the fetal gastrointestinal tract.13-15 Seventy percent to 95% of patients with primary hepatocellular carcinoma have elevated AFP values.16 The later the stage of nonseminomatous germ cell tumors, the higher the AFP values. Human chorionic gonadotropin (hCG) and AFP are important parameters for estimating the survival rate of patients with advanced, nonseminomatous germ cell tumors.17-19

No correlation between the AFP concentration and tumor size, tumor growth, stage, or degree of malignancy has so far been demonstrated. Greatly elevated AFP values generally indicate primary liver cell carcinoma. When liver metastasis exists, the AFP values are generally <350-400 IU/mL.20 As the AFP values rise during regeneration of the liver, moderately elevated values are found in alcohol-mediated liver cirrhosis and acute viral hepatitis as well as in carriers of HBsAg.20,21


Footnotes

1. Javadpour N, McIntire KR, Waldmann TA. Human chorionic gonadotropin (HCG) and alpha-fetoprotein (AFP) in sera and tumor cells of patients with testicular seminoma: A prospective study. Cancer. 1978 Dec; 42(6):2768-2772. 83187
2. Lange PH, McIntire KR, Waldmann TA, Hakala TR, Fraley EE. Serum alpha fetoprotein and human chorionic gonadotropin in the diagnosis and management of nonseminomatous germ-cell testicular cancer. N Engl J Med. 1976 Nov 25; 295(22):1237-1240. 62281
3. Javadpour N, McIntire KR, Waldmann TA, Scardino PT, Bergman S, Anderson T. The role of the radioimmunoassay of serum alpha-fetoprotein and human chorionic gonadotropin in the intensive chemotherapy and surgery of metastatic testicular tumors. J Urol. 1978 Jun; 119(6):759-762. 77918
4. Kohn J, Orr AH, McElwain TJ, Bentall M, Peckham MJ. Serum-alpha1-fetoprotein in patients with testicular tumours. Lancet. 1976 Aug 28; 2(7983):433-436. 73740
5. Perlin E, Engeler JE Jr, Edson M, Karp D, McIntire KR, Waldmann TA. The value of serial measurement of both human chorionic gonadotropin and alpha-fetoprotein for monitoring germinal cell tumors. Cancer. 1976 Jan; 37(1):215-219. 55299
6. Scardino PT, Cox HD, Waldmann TA, Mcintire KR, Mittemeyer B, Javadpour N. The value of serum tumor markers in the staging and prognosis of germ cell tumors of the testis. J Urol. 1977 Dec; 118(6):994-999. 72833
7. Javadpour N. The role of biologic tumor markers in testicular cancer. Cancer. 1980 Apr 15; 45(7 Suppl):1755-1761. 6154517
8. Mason MD. Tumour markers. In: Horwich A, ed. Testicular Cancer Investigation and Management. Baltimore, Md: Williams and Wilkins;1991:35-50.
9. Toner GC, Geller NL, Tan C, Nisselbaum J, Bosl GJ. Serum tumor marker half-life during chemotherapy allows early prediction of complete response and survival in nonseminomatous germ cell tumors. Cancer Res. 1990 Sep 15; 50(18):5904-5910. 1697503
10. Kirkpatrick AM, Kirkpatrick KA. Clearance-corrected differencing and other analytic techniques useful in the interpretation of serum AFP values. In: Kirkpatrick AM, Nakamura RM, eds. Alpha-Fetoprotein: Laboratory Procedures and Clinical Applications. New York, NY: Masson;1981:135-148.
11. Price P, Hogan SJ, Horwich A. The growth rate of metastatic non-seminomatous germ cell testicular tumours measured by marker production doubling time--I. Theoretical basis and practical application. Eur J Cancer.1990; 26(4):450-453. 1694086
12. AFP on Elecsys 1010/2010 and Modular Analytics E170, package insert 2006-05, V2, Indianapolis, Ind: Roche Diagnostics; 2006.
13. Taketa K. Alpha-Fetoprotein in the 1990s. In: Sell SS, ed. Serological Cancer Markers. Humana Press;1992:31-46.
14. Ruoslathi E, Engvall E, Kessler MJ. Chemical properties of alpha-fetoprotein. In: Herberman RB, McIntire KR, eds. Immunodiagnosis of Cancer. New York: Marcel Dekker Inc;1979:101-117.
15. Diamandis EP, Fritsche HA, Lilja H, et al. Tumor Markers: Physiology, Pathobiology, Technology, and Clinical Applications. Washington, DC: AACC Press;2002.
16. Ramsey WH, Wu GY. Hepatocellular carcinoma: Update on diagnosis and treatment. Dig Dis. 1995 Mar-Apr; 13(2):81-91. 7586635
17. Sato Y, Nakata K, Kato Y, et al. Early recognition of hepatocellular carcinoma based on altered profiles of alpha-fetoprotein. N Engl J Med. 1993 Jun 24; 328(25):1802-1806. 7684823
18. Klepp O. Serum tumor markers in testicular and extragonadal germ cell malignancies. Scand J Clin Lab Invest Suppl. 1991; 206:28-41. 1947758
19. Sturgeon C. Practice guidelines for tumor marker use in the clinic. Clin Chem. 2002 Aug; 48(8):1151-1159. 12142367
20. Fateh-Moghadam A, Stieber P. Sensible Use of Tumor Markers. Boehringer Mannheim;1994. Catalog N° 1536869.
21. Stuart KE, Anand AJ, Jenkins RL. Hepatocellular carcinoma in the United States. Prognostic features, treatment outcome, and survival. Cancer. 1996 Jun 1; 77(11):2217-2222. 8635087

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
002253 AFP, Serum, Tumor Marker 53962-7 002266 AFP, Serum, Tumor Marker ng/mL 53962-7

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