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Comparison of 5 Immunohistochemical Markers of Hepatocellular Differentiation for the Diagnosis of Hepatocellular Carcinoma.

用于诊断肝细胞癌的5种肝细胞分化免疫组化标记物比较

Nguyen T,Phillips D,Jain D,Torbenson M,Wu TT,Yeh MM,Kakar S

Abstract

Context .- Several immunohistochemical markers are available to establish the diagnosis of hepatocellular carcinoma. Judicious selection is essential to achieve a reliable diagnosis in limited tissue provided by liver biopsy. Objective .- To compare the efficacy of 5 hepatocellular markers for the diagnosis of hepatocellular carcinoma across various levels of differentiations. Design .- Immunohistochemistry for hepatocyte paraffin antigen 1 (Hep Par 1), polyclonal carcinoembryonic antigen (CEA), glypican-3, arginase-1, and bile salt export pump transporter was performed in 79 hepatocellular carcinomas, yielding 93 observations (13 well-differentiated [14%], 41 moderately differentiated [44%], and 39 poorly differentiated [42%] tumors). Results .- Arginase-1 and Hep Par 1 had the highest sensitivity for well-differentiated hepatocellular carcinoma, whereas arginase-1 and glypican-3 had the highest sensitivity for poorly differentiated hepatocellular carcinoma. When staining of more than 50% of the tumor was considered a positive result, arginase-1 remained the most sensitive marker for all differentiations, whereas sensitivity for Hep Par 1 in poorly differentiated hepatocellular carcinoma dropped to 30% and that of glypican-3 in well-differentiated hepatocellular carcinoma was 15%. The addition of Hep Par 1 and/or polyclonal CEA to arginase-1 did not lead to an increase in sensitivity for any differentiation. The combined use of arginase-1 and glypican-3 yielded 100% sensitivity for poorly differentiated hepatocellular carcinoma. Conclusion .- Arginase-1 was the most sensitive marker in all differentiations of hepatocellular carcinoma. Glypican-3 had high sensitivity for poorly differentiated cases and its combined use with arginase-1 enabled identification of nearly all cases of poorly differentiated hepatocellular carcinoma. Although bile salt export pump transporter has good overall sensitivity, it has a limited role in establishing hepatocellular differentiation when added to a panel of arginase-1 with either glypican-3 or Hep Par 1.

摘要

前言:目前已有一些免疫组化标记物对于诊断肝细胞癌有帮助。一些肝活检获取的组织有限时,审慎的选择标记物对于得到可靠诊断是必需的。目的:在诊断不同分化程度的肝细胞癌中,比较5种肝细胞标记物的效率。设计:免疫组化检测79例肝细胞癌中Hep Par 1、多克隆CEA、glypican-3、arginase-1,和bile salt export pump transporter,合计93次检测 (13次高分化[14%],41次中分化[44%],39次低分化[42%])。结果: Arginase-1和Hep Par 1对于高分化肝细胞癌敏感性最高,而arginase-1和glypican-3对于低分化肝细胞癌敏感性最高。当超过50%肿瘤染色方为阳性结果时,arginase-1对于各种分化依然为最敏感的标记物,而Hep Par 1的敏感性在低分化肝细胞癌降至30%,glypican-3在高分化肝细胞癌敏感性为15%。arginase-1染色加做Hep Par 1和/或多克隆 CEA对于提高任何分化程度的敏感性没有帮助。联合应用arginase-1和glypican-3在低分化肝细胞癌的敏感性为100%。结果:对于各种分化的肝细胞癌Arginase-1是最敏感的标记物。Glypican-3对于低分化病例敏感性高,它联合应用arginase-1可以识别几乎所有的低分化肝细胞癌病例。尽管bile salt export pump transporter总的敏感性好,在arginase-1联合glypican-3或Hep Par 1的免疫组化套餐中,加做该指标的作用有限。.


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