Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Programa de Pós-Graduação em Medicina: Hepatologia, Porto Alegre, RS, Brasil.
Irmandade da Santa Casa de Misericórdia de Porto Alegre, Departamento de Radiologia, Porto Alegre, RS, Brasil.
Arq Gastroenterol. 2021 Jan-Mar;58(1):82-86. doi: 10.1590/S0004-2803.202100000-14.
Hepatocellular carcinoma (HCC) is the most frequent primary cancer of the liver and cirrhosis is considered a pre-malignant disease. In this context, the evolutionary sequence from low grade dysplastic nodule and high grade dysplastic nodule (HGDN) to early HCC and advanced HCC has been studied. The differential diagnosis between HGDN and early HCC is still a challenge, especially in needle biopsies.
To evaluate an immunohistochemistry panel to differentiate dysplastic nodules and HCC.
Patients with cirrhosis who underwent surgical resection or liver transplantation were included. The sensitivity, specificity and accuracy for the diagnosis of neoplasia were analyzed by evaluating five markers: heat shock protein 70, glypican 3, glutamine synthetase, clathrin heavy chain and beta-catenin. P≤0.05 was considered statistically significant.
One hundred and fifty-six nodules were included; of these, 57 were HCC, 14 HGDN, 18 low grade dysplastic nodules and 67 regenerative macronodules. Sensitivity of HCC diagnosis was 64.9% for glypican 3 and 77.2% for glutamine syntetase, while specificity was 96.0% and 96.0% respectively. When the panel of four markers was considered (excluding beta catenin), the specificity ranged from 87.9% for one positive marker to 100% for at least three markers. The best accuracy for HCC diagnosis was obtained with at least two positive markers, which was associated with a sensitivity of 82.5% and specificity of 99%.
Differential diagnosis of dysplastic nodules and HCC by morphological criteria can be challenging. Immunomarkers are useful and should be used for the differential diagnosis between HCC and HGDN.
肝细胞癌（HCC）是最常见的原发性肝癌，肝硬化被认为是癌前病变。在此背景下，已经研究了从低级别异型增生结节和高级别异型增生结节（HGDN）到早期 HCC 和晚期 HCC 的演变序列。HGDN 和早期 HCC 的鉴别诊断仍然具有挑战性，尤其是在针吸活检中。
评估一组免疫组织化学标志物以鉴别异型增生结节和 HCC。
纳入接受手术切除或肝移植的肝硬化患者。通过评估五种标志物（热休克蛋白 70、Glypican 3、谷氨酰胺合成酶、网格蛋白重链和β-连环蛋白）来分析肿瘤诊断的敏感性、特异性和准确性。P≤0.05 被认为具有统计学意义。
共纳入 156 个结节；其中 57 个为 HCC，14 个为 HGDN，18 个为低级别异型增生结节，67 个为再生性大结节。Glypican 3 诊断 HCC 的敏感性为 64.9%，谷氨酰胺合成酶的敏感性为 77.2%，而特异性分别为 96.0%和 96.0%。当考虑四个标志物的组合（排除β连环蛋白）时，特异性范围为一个阳性标志物的 87.9%到至少三个标志物的 100%。至少有两个阳性标志物诊断 HCC 的准确性最高，其敏感性为 82.5%，特异性为 99%。
仅凭形态学标准鉴别异型增生结节和 HCC 具有挑战性。免疫标志物很有用，应该用于 HCC 和 HGDN 的鉴别诊断。
