Abstract
Albumin, widely recognized as a highly sensitive and specific marker of hepatocellular carcinoma (HCC), is currently unavailable in the diagnostic laboratory because of the lack of a robust platform. In a prior study we detected albumin mRNA in the majority of intrahepatic cholangiocarcinomas using a novel branched chain RNA in situ hybridization (ISH) platform. We now explore the utility of albumin ISH as a marker of hepatocellular differentiation in HCCs, and compare its sensitivity with Hep Par 1 and Arginase-1. We evaluated 93 HCCs and its mimics including neuroendocrine tumors of the gastrointestinal tract (n=31), neuroendocrine tumors of the pancreas (n=163), melanoma (n=15), and gallbladder carcinoma (n=34). We performed ISH for albumin and immunohistochemistry for Hep Par 1 and Arginase-1. Five previously uncharacterized hepatic neoplasms from our files were also evaluated. Immunohistochemistry for Arginase-1 was performed on 59 intrahepatic cholangiocarcinomas. In addition, 43 HCCs evaluated on the manual platform were also examined on the automated instrument. Fifty-five percent of HCCs were moderately differentiated and 39% poorly differentiated. The sensitivity of ISH for albumin was 99%, with 92 of 93 HCCs staining positive for albumin. In contrast to ISH, the sensitivity of immunohistochemistry for Hep Par 1 and Arginase-1 was 84% and 83%, respectively. The sensitivity of albumin for poorly differentiated HCCs was 99%, whereas that for Arginase-1 and Hep Par 1 was 71% and 64%, respectively. Ninety-seven percent of the HCCs showed albumin positivity in >50% of tumor cells using the ISH platform, as compared with 76% and 70% for Hep Par 1 and Arginase-1 immunohistochemistry, respectively. Three of the 5 previously uncharacterized neoplasms were positive for albumin ISH. Automated albumin ISH platform performed equivalently to the manual format, with albumin reactivity in >50% of tumor cells in all 43 cases that were tested on both platforms. All non-HCCs were negative for albumin. All 59 intrahepatic cholangiocarcinomas were negative for Arginase-1. In conclusion, branched chain ISH performed on manual and automated mode is a robust assay for detecting albumin with sensitivity for poorly differentiated HCCs superior to Arginase-1 and Hep Par 1. When interpreted in conjunction with Arginase-1, albumin ISH offers a high level of sensitivity and specificity.
摘要
众所周知,白蛋白是肝细胞癌(HCC)一个高度敏感和特异的标记物,但由于缺乏一个有力的平台,目前诊断实验室还不能对其进行检测。之前的研究中,我们应用一种独特支链RNA原位杂交(ISH) 的方法在大多数肝内胆管细胞癌中检测到了白蛋白mRNA。目前我们对93例肝细胞癌和包括胃肠道神经内分泌肿瘤 (n=31)、胰腺神经内分泌肿瘤 (n=163)、恶性黑色素瘤 (n=15)及胆囊癌 (n=34)在内的容易与肝细胞癌混淆的肿瘤进行了评估,旨在探索白蛋白ISH作为肝细胞癌肝细胞分化标记物的有效性,并将其敏感性与Hep Par 1和Arginase-1进行了比较。我们应用原位杂交检测白蛋白,免疫组化检测Hep Par 1 和 Arginase-1。并对我们档案中以前未明确的5例肝脏肿瘤也进行了评估。我们应用免疫组化检测了59例肝内胆管细胞癌中Arginase-1的表达。此外,我们同时应用手工操作和自动化仪器对43例肝细胞癌进行了检测和评估。其中中分化肝癌55%,低分化肝癌39%。ISH检测白蛋白对于肝细胞癌的敏感性为99%,93例肝细胞癌中92例白蛋白阳性表达。较之ISH,应用免疫组化检测Hep Par 1和Arginase-1的敏感性分别为84%和83%。低分化肝细胞癌中,白蛋白的敏感性为99%,而 Arginase-1和Hep Par 1分别为 71%、64%。 应用ISH进行检测时,97%的肝细胞癌中,超过50%的肿瘤细胞白蛋白阳性表达,而应用免疫组化进行 Hep Par 1和 Arginase-1的检测时,阳性率分别为76%和70%。5例以前未明确的肿瘤中有3例应用ISH检测,白蛋白阳性表达。自动化白蛋白ISH仪的检测与人工检测结果相当。应用两种方法检测的所有43例病例中超过50%的肿瘤细胞有白蛋白表达。所有非肝细胞癌白蛋白不表达。59例肝内胆管细胞癌Arginase-1阴性表达。总之,应用自动化或人工操作的支链白蛋白ISH检测对于低分化肝细胞癌来说,在敏感性上优于Arginase-1和Hep Par 1。联合检测Arginase-1时,白蛋白ISH将有更高的诊断敏感性和特异性。
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