PIVKA‑II value in the diagnosis of hepatocellular carcinoma in patients with inconclusive imaging findings or AFP levels.

Objective: To evaluate the diagnostic accuracy of Protein Induced by Vitamin K Absence-II (PIVKA‑II; des-γ-carboxy prothrombin) in patients with suspected HCC who had nondiagnostic AFP or atypical imaging findings. Study Design: Retrospective Cross-sectional study. Setting: Rehman Medical Research Institute, Peshawar. Period: May 2018 and September 2024. Methods: Among 128 patients with suspected HCC the patients were 106 men and twenty two women, average age 60.3 years. Data from electronic medical records including demographics, hepatitis status, imaging results, laboratory markers and biopsy results were collected. PIVKA-II levels were analyzed and diagnostic accuracy has been calculated (sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and overall accuracy). The performance of PIVKA-II was evaluated by receiver operating characteristic curve analysis. Results: Of 128 patients, 86 (67.2%) had HCC confirmed on biopsy. PIVKA‑II was abnormal in 81/128 patients (71 HCC, 10 non-HCC). Using these counts, PIVKA‑II showed sensitivity 82.6%, specificity 76.2%, PPV 87.7%, NPV 68.1%, and accuracy 80.5%. AUROC was 0.776 (p = 0.002). Conclusion: PIVKA-II is a useful biomarker for diagnosis of HCC when AFP is non-diagnostic or imaging results are inconclusive. It demonstrates high sensitivity and reasonable specificity to justify its use for early detection and differentiation of HCC from other liver lesions. Future studies should address the limitations of this single-institution, retrospective study to confirm the clinical utility of PIVKA-II.