From large to small: The immunohistochemical panel in the diagnosis of early hepatocellular carcinoma

Abstract

Aims

(i) to validate the immunohistochemical (IHC) markers Glutamine Synthetase (GS), Glypican-3 (GPC3), Heat Shock Protein-70 (HSP70) and Enhancer of Zeste homologue 2 (EZH2) on liver biopsy for the differential diagnosis between small HCC and non-neoplastic liver nodules, with special attention on <1 cm nodules; (ii) to assess the actual sensitivity and specificity of the single markers, and their combination, on needle biopsies.

Methods and Results

One-hundred (100) liver nodules, 66 HCC and 34 non-neoplastic nodules, were prospectively collected from 43 consecutive OLT patients, and subjected to "backtable" needle biopsies directly on surgical specimen. IHC was semi-automatically performed with Benchmark^® ultra immunostainer. The morphological and IHC diagnosis on surgical specimen was considered "gold standard".

GS, GPC3, HSP70 and EZH2 showed 16.6%, 10.7%, 28.8%, and 62.1% decrease in sensitivity respectively from surgical specimen to needle biopsy. Higher decreases were observed in <1 cm nodules. In 18 HCC with no morphological diagnostic features of malignancy on biopsy, GPC3 or GS were positive in 16; in 7 HCC neither morphology nor IHC ruled out the differential diagnosis on needle biopsy.

Conclusions

We present for the first time a direct confrontation between surgical specimens and needle biopsies to confirm the usefulness and reproducibility of the most widely used antibodies for the diagnosis of small liver nodules. Our results recommend the use of IHC on biopsy for the diagnosis of small liver lesions, albeit the IHC panel could result negative also in front of obvious HCC and false positive should always be considered.

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from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2wL24ly