AFP and hepatocellular carcinoma: For early-stage HCC, however, performance is substantially lower: ultrasonography alone yields a sensitivity of only 47–53% (specificity 91–96%), and adding AFP increases sensitivity modestly to about 63% (specificity 85–90%), implying that even with combined testing, nearly one-third of early HCC cases remain undetected [9,33,34,35,36,37,38].