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Peer-reviewedCC BYBMC Gastroenterology

Diagnostic performance of GAAD, PIVKA-II and AFP in hepatocellular carcinoma, chronic liver disease and healthy population: evidence from a Malaysian cohort

  • Rabiatul Adawiyyah Mohamad Noor1
  • Nur Karyatee Kassim1
  • Aniza Mohammed Jelani1
  • Lee Yeong Yeh2
  • Mohd Hafizuddin Husin3
  • Wan Muhamad Amir W Ahmad4
  • Nurhanis Syazni Roslan5
5 affiliations
  1. 1Department of Chemical Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia
  2. 2Department of Internal Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia
  3. 3Department of Radiology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia
  4. 4School of Dental Sciences, Health Campus, Universiti Sains Malaysia
  5. 5Department of Medical Education, School of Medical Sciences, Health Campus, Universiti Sains Malaysia
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Abstract

Background The aim of the current study was to evaluate the diagnostic performances of GAAD score, PIVKA-II and alpha-fetoprotein (AFP) for hepatocellular carcinoma (HCC) surveillance in HCC, chronic liver disease (CLD) and healthy controls (HC) subjects from the northeastern Peninsular Malaysia. Methods This was a single-center cross-sectional study. The GAAD value was calculated using the Elecsys® GAAD calculator. Serum PIVKA-II and AFP levels were measured using the Elecsys® electrochemiluminescence immunoassay method. Diagnostic performance of these tests were evaluated based on area under the curve (AUC), optimal cutoff levels, sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Results Of the 128 enrolled subjects,99 were included (33 HCC, 33 CLD, and 33 HC). GAAD score, PIVKA-II, and AFP levels were significantly higher in patients with HCC than in those with CLD and HC (all p < 0.05). For differentiating HCC from CLD, GAAD at a cutoff of 2.57 demonstrated the highest Se (81.8%) and Sp (72.7%), with an AUC of 0.873 (95% CI 0.791–0.955). PIVKA-II at a cut-off of 28.4 ng/mL showed Se and Sp of 75.8% and 69.7%, respectively, with an AUC of 0.842 (95% CI 0.748–0.936). AFP at a cutoff of 20 ng/mL demonstrated lower Se (51.5%) but higher Sp (90.9%), with an AUC of 0.834 (95% CI 0.730–0.938). For differentiating HCC from HC, GAAD and PIVKA-II achieved 100% Sp and PPV, whereas AFP maintained 100% Sp but lower Se (51.52%). Overall, GAAD exhibited the best balance of sensitivity and specificity for HCC detection, while PIVKA-II provided complementary diagnostic value due to its high specificity. Conclusion The GAAD score demonstrated superior diagnostic performance compared with both PIVKA-II and AFP in differentiating HCC from CLD and HC subjects, supporting its potential utility in HCC surveillance. In addition, PIVKA-II showed better diagnostic performance than AFP.

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Cite

BibTeXRIS
BibTeX
@article{noor2026diagnostic,
  title = {{Diagnostic performance of GAAD, PIVKA-II and AFP in hepatocellular carcinoma, chronic liver disease and healthy population: evidence from a Malaysian cohort}},
  author = {Rabiatul Adawiyyah Mohamad Noor and Nur Karyatee Kassim and Aniza Mohammed Jelani and Lee Yeong Yeh and Mohd Hafizuddin Husin and Wan Muhamad Amir W Ahmad and Nurhanis Syazni Roslan},
  journal = {BMC Gastroenterology},
  year = {2026},
  month = jul,
  doi = {10.1186/s12876-026-05140-6},
  url = {https://doi.org/10.1186/s12876-026-05140-6},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Diagnostic performance of GAAD, PIVKA-II and AFP in hepatocellular carcinoma, chronic liver disease and healthy population: evidence from a Malaysian cohort
AU  - Rabiatul Adawiyyah Mohamad Noor
AU  - Nur Karyatee Kassim
AU  - Aniza Mohammed Jelani
AU  - Lee Yeong Yeh
AU  - Mohd Hafizuddin Husin
AU  - Wan Muhamad Amir W Ahmad
AU  - Nurhanis Syazni Roslan
PY  - 2026
DA  - 2026/07/01
JO  - BMC Gastroenterology
DO  - 10.1186/s12876-026-05140-6
UR  - https://doi.org/10.1186/s12876-026-05140-6
AB  - Background The aim of the current study was to evaluate the diagnostic performances of GAAD score, PIVKA-II and alpha-fetoprotein (AFP) for hepatocellular carcinoma (HCC) surveillance in HCC, chronic liver disease (CLD) and healthy controls (HC) subjects from the northeastern Peninsular Malaysia. Methods This was a single-center cross-sectional study. The GAAD value was calculated using the Elecsys® GAAD calculator. Serum PIVKA-II and AFP levels were measured using the Elecsys® electrochemiluminescence immunoassay method. Diagnostic performance of these tests were evaluated based on area under the curve (AUC), optimal cutoff levels, sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV). Results Of the 128 enrolled subjects,99 were included (33 HCC, 33 CLD, and 33 HC). GAAD score, PIVKA-II, and AFP levels were significantly higher in patients with HCC than in those with CLD and HC (all p < 0.05). For differentiating HCC from CLD, GAAD at a cutoff of 2.57 demonstrated the highest Se (81.8%) and Sp (72.7%), with an AUC of 0.873 (95% CI 0.791–0.955). PIVKA-II at a cut-off of 28.4 ng/mL showed Se and Sp of 75.8% and 69.7%, respectively, with an AUC of 0.842 (95% CI 0.748–0.936). AFP at a cutoff of 20 ng/mL demonstrated lower Se (51.5%) but higher Sp (90.9%), with an AUC of 0.834 (95% CI 0.730–0.938). For differentiating HCC from HC, GAAD and PIVKA-II achieved 100% Sp and PPV, whereas AFP maintained 100% Sp but lower Se (51.52%). Overall, GAAD exhibited the best balance of sensitivity and specificity for HCC detection, while PIVKA-II provided complementary diagnostic value due to its high specificity. Conclusion The GAAD score demonstrated superior diagnostic performance compared with both PIVKA-II and AFP in differentiating HCC from CLD and HC subjects, supporting its potential utility in HCC surveillance. In addition, PIVKA-II showed better diagnostic performance than AFP.
SN  - 1471-230X
ER  -