Prospective validation of an immunohistochemical panel (glypican 3, heat shock protein 70 and glutamine synthetase) in liver biopsies for diagnosis of very early hepatocellular carcinoma
ABSTRACT Conventional pathological analysis fails to achieve sufficient sensitivity and specificity for the diagnosis of hepatocellular carcinoma (HCC) in small nodules. Immunohistochemical staining for glypican 3 (GPC3), heat shock protein 70 (HSP70) and glutamine synthetase (GS) has been suggested to allow a confident diagnosis but no prospective study has established the diagnostic accuracy of this approach. The aim of this study is to assess prospectively the diagnostic accuracy of a panel of markers (GPC3, HSP70, GS) for the diagnosis of HCC in patients with cirrhosis with a small (5-20 mm) nodule detected by ultrasound screening.
Sixty patients with cirrhosis with a single nodule 5-20 mm newly detected by ultrasound were included in the study. Contrast-enhanced ultrasound, magnetic resonance and fine needle biopsy of the nodule (gold standard) were performed; the biopsy was repeated in case of diagnostic failures. Three consecutive sections of the first biopsy sample with meaningful material were stained with antibodies against GPC3, HSP70 and GS.
Forty patients were diagnosed with HCC. The sensitivity and specificity for HCC diagnosis were: GPC3 57.5% and 95%, HSP70 57.5% and 85%, GS 50% and 90%, respectively. The sensitivity and specificity of the different combinations were: GPC3+HSP70 40% and 100%; GPC3+GS 35% and 100%; HSP70+GS 35% and 100%; GPC3+HSP70+GS 25% and 100%. When at least two of the markers were positive (regardless of which), the sensitivity and specificity were 60% and 100%, respectively. Conventional pathological analysis yielded three false negative results, but the addition of this panel only correctly classified one of these cases as HCC.
These data within a prospective study establish the clinical usefulness of this panel of markers for the diagnosis of early HCC. However, the panel only slightly increases the diagnostic accuracy in an expert setting.
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ABSTRACT: Colorectal cancer is the second leading cause of cancer-related death. Prevention of this neoplasm should be achievable by screening programs in asymptomatic patients. The objective of the present paper is to assess colonoscopic findings in asymptomatic people submitted to screening. A prospective study was undertaken on 153 consecutive asymptomatic people submitted to colonoscopy. Sex, age, previous diseases, and familial cases of cancer, as well as tobacco and alcohol ingestion were assessed. Patients with rectal macro- or microscopic bleeding and colorectal diseases were excluded. Bowel cleansing, polyps, angioectasias, diverticular disease, inflammation, and neoplasm were also verified. Polyps were classified according to their size, number, and location. Colonoscopic alterations were detected in 99 individuals: polyps in 64.3 %, diverticular disease in 27.9 %, inflammatory mucosal alterations in 9.7 %, melanosis coli in 2.6 %, and angioectasias in 7.8 %. There was an increasing incidence of polyps in individuals older than 50 years. Multivariate logistic regression showed age and sex as predictive factors for polyps [odds ratio (OR) = 1.43; 1.19 < OR < 2.67]. The results of this investigation revealed a significant incidence of colonoscopic alterations in asymptomatic people submitted to colonoscopy for colorectal cancer screening.Surgical Endoscopy 05/2012; 26(11):3157-62. DOI:10.1007/s00464-012-2308-2 · 3.31 Impact Factor
- Gut 07/2012; 61(10):1514-5. DOI:10.1136/gutjnl-2012-301994 · 13.32 Impact Factor
- Journal of Hepatology 11/2012; 58(2). DOI:10.1016/j.jhep.2012.11.005 · 10.40 Impact Factor