Primarily used as a tumor marker for Hepatocellular Carcinoma (HCC)
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DCP-Decarboxy Prothrombin PIVKA-II Test Information Guide
DCP-Decarboxy Prothrombin PIVKA-II
Why is it done?
Detects abnormal prothrombin produced by hepatocellular carcinoma (HCC) and cirrhotic liver tissue
Screening and surveillance for hepatocellular carcinoma in high-risk patients with chronic liver disease, cirrhosis, and hepatitis B or C
Early detection of HCC before imaging studies can identify tumors (tumor marker in early stages)
Monitoring treatment response and disease progression in HCC patients
Performed at baseline evaluation and during regular surveillance intervals (every 3-6 months) in at-risk populations
Used in combination with AFP (alpha-fetoprotein) and imaging studies for comprehensive HCC assessment
Normal Range
Reference Range: < 40 mAU/mL (milliarbitrary units per milliliter) or < 0.1 ng/mL
Normal Result: Negative or undetectable DCP levels indicate no evidence of HCC or minimal hepatocellular activity
Abnormal Result: Elevated levels (≥ 40 mAU/mL) may indicate HCC or advanced cirrhosis
Borderline Range: 40-400 mAU/mL - warrants careful clinical correlation and possible repeat testing
Significantly Elevated: > 400 mAU/mL - strongly suggestive of HCC
Units of Measurement: mAU/mL (milliarbitrary units per milliliter) or ng/mL (nanograms per milliliter)
Interpretation
Negative/Normal Results (< 40 mAU/mL): No detectable DCP; unlikely to have HCC at present, though does not completely exclude early disease. May represent normal liver function or benign liver conditions.
Mildly Elevated (40-100 mAU/mL): May indicate early HCC, advanced cirrhosis, or chronic hepatitis. Requires clinical correlation with imaging and other markers (AFP, ultrasound, CT/MRI).
Moderately Elevated (100-400 mAU/mL): Moderately suggestive of HCC; strongly warrants confirmatory imaging and detailed evaluation. May also be seen in cirrhosis without HCC.
Highly Elevated (> 400 mAU/mL): Highly suggestive of HCC; strongly indicative of advanced disease with significant hepatocellular carcinoma burden
Progressive Elevation: Rising DCP levels on serial testing indicate disease progression or inadequate treatment response
Declining Levels: Decreasing DCP after treatment may indicate good treatment response, though persistent elevation suggests residual disease
Factors Affecting Results: Vitamin K deficiency (may falsely elevate), liver function status, extent of cirrhosis, concurrent HBV/HCV infection, chemotherapy, and ablation procedures
Clinical Significance: DCP has superior specificity for HCC compared to AFP alone, particularly valuable in detecting early-stage HCC. Serial monitoring provides prognostic information and treatment response assessment.
Associated Organs
Primary Organ: Liver - DCP is produced by malignant and cirrhotic hepatocytes
Diseases Detected/Monitored: Primary hepatocellular carcinoma, advanced cirrhosis with malignant transformation, recurrent HCC, metastatic disease to liver
Related Organ Complications: Portal hypertension, esophageal varices, ascites, hepatic encephalopathy, coagulopathy, and hepatorenal syndrome in advanced HCC/cirrhosis
Metastatic Complications: HCC can metastasize to lungs, bones, brain, and distant lymph nodes; elevated DCP may correlate with metastatic burden
Follow-up Tests
Complementary Biomarkers: Alpha-fetoprotein (AFP), AFP-L3 isoform, GP73 (Golgi protein 73), and other serum markers for comprehensive HCC assessment
Imaging Studies: Ultrasound (US), contrast-enhanced CT (computed tomography), dynamic contrast-enhanced MRI (magnetic resonance imaging) to visualize and characterize liver lesions
Liver Function Tests: AST, ALT, alkaline phosphatase, bilirubin, albumin, and PT/INR to assess hepatic synthetic function and disease severity
Viral Serology: Hepatitis B surface antigen (HBsAg), Hepatitis B core antibody (anti-HBc), Hepatitis C antibody (anti-HCV), viral load testing if positive
Fibrosis Assessment: FIB-4 index, APRI score, elastography (transient or shear wave), or liver biopsy to assess cirrhosis severity
Biopsy: Liver biopsy if imaging findings are inconclusive and tissue diagnosis is needed to confirm HCC
Staging Studies: Chest CT, bone scan, or PET-CT for metastatic disease staging in confirmed HCC cases
Monitoring Frequency: For cirrhotic patients without HCC: every 3-6 months; For HCC patients: every 1-3 months depending on treatment phase and risk; Post-treatment surveillance: as per institutional protocol (typically every 3-4 months for 2 years, then every 4-6 months)
Related Tumor Markers: Combined score systems (GALAD score, HCC-TORE) using DCP with other markers for improved diagnostic accuracy
Fasting Required?
Fasting Required: No - Fasting is NOT required for this test. The test can be performed at any time of day without food or fluid restrictions.
Specimen Collection: 5-10 mL of venous blood collected in a serum separator tube (SST) or EDTA tube depending on laboratory protocol
Medications to Avoid: No specific medication restrictions; however, patients on anticoagulants (warfarin, DOACs) should inform the phlebotomist to prevent hematoma formation
Patient Preparation: Patient should be well-hydrated; sit comfortably for 5 minutes prior to blood draw; inform healthcare provider of any active bleeding disorders or current anticoagulation therapy
Specimen Handling: Blood sample should be allowed to clot at room temperature for 30 minutes, centrifuged at 1200-1500 g for 10 minutes, and serum stored at 2-8°C if testing is delayed
Timing Considerations: Test can be performed at any time; consistency in timing (similar time of day) may be preferred for serial monitoring to minimize diurnal variation effects
Laboratory Turn-Around Time: Typically 2-7 business days; results may be available faster at specialized hepatology centers with in-house testing capabilities