Comparison of Hepatocellular Markers for Diagnosis of Poorly-Differentiated Hepatocellular Carcinoma: High Sensitivity with Combined Use of Arginase-1 and Glypican-3
Daniel GK Phillips, Dhanpat Jain, Michael Torbenson, Tsung-Teh Wu, Matthew MC Yeh, Sanjay Kakar. University of California, San Francisco, San Francisco, CA; Yale-New Haven Hospital, New Haven, CT; The Johns Hopkins Hospital, Baltimore, MD; Mayo Clinic, Rochester, MN; University of Washington, Seattle, WA
Background: Evidence-based use of immunohistochemistry is important in poorly-differentiated liver tumors,especially when limited tissue is available. Commonly used hepatocellular markers like Hep Par 1(Hep) and polyclonal carcinoembryonic antigen(pCEA) have low sensitivity for poorly differentiated HCC(PD-HCC). This study compares the efficacy of four hepatocellular markers in HCC.
Design: Immunohistochemistry for Hep,pCEA, glypican-3(GPC) and arginase-1(Arg) was done on well-(WD),moderately- differentiated(MD) and PD-HCC cases (n=75). In 13 cases,there was >1 differentiation pattern,which were scored separately yielding 88 observations. Staining intensity of 2+ or 3+ (scale 0-3) in >5% of tumor cells was considered positive.
Results: Arg and Hep had the highest sensitivity for WD-HCC,while Arg and GPC had the highest sensitivity for PD-HCC. When staining of >50% of tumor was considered positive,Arg was the most sensitive marker for all differentiations. The addition of Hep or pCEA to Arg did not lead to increased sensitivity. Combined use of Arg and GPC yielded 100% sensitivity for PD-HCC. When staining of >50% of tumor was considered positive,the sensitivity of combined Arg and GPC was 94%.