Surveillance and diagnosis of hepatocellular carcinoma in patients with cirrhosis

Table 4 Immunohistochemistry for HCC

Marker	Staining pattern	Diagnostic use	Diagnostic value	Ref.
AFP	Specific for HCC Cytoplasm	Expressed in HCC cells cytoplasm but also in: fetal liver, hepatoid tumors, germ cells tumors	Sensitivity 17%-68%	[89-104]
			Specificity 97%
			For HCC
GP-3	Specific for HCC Cytoplasm	Expressed in HCC cell cytoplasm (less so if fibrolamellar or sarcomatoid variants) but also in: fetal liver, hepatoblastoma, melanoma	Sensitivity 49%-91%	[81,109-115]
			Specificity 89%-100%
			For HCC
CD-34	Endothelium	Surface of normal endothelium and HCC trabeculae or acini but also in: myelodysplasia in transformation, GI stromal tumors (high coexpression with bcl-2)	HCC positivity 82%	[117]
p-CEA	Biliary canalicula	Identifies biliary glycoprotein 1 on hepatocyte canalicular pole and cholangiocyte. Useful for differential diagnosis vs cholangiocarcinoma, other adenocarcinoma	HCC positivity 24%-90%	[94,98,100,118-128]
CD-10	Biliary canalicula	Surface of biliary tract cells and in HCC, but also positive in: B cell lymphomas, renal cells carcinoma, melanoma, prostate and pancreas adenocarcinoma. Useful for differential diagnosis vs cholangiocarcinoma, other adenocarcinomas	HCC positivity 28%-86%	[94,98,100,119,120,122-124,126,128]
Ki67 HepPar1	Cell proliferation marker HCC & normal Hepatocyte citoplasm	Assessing cell proliferation rate, correlates with tumor grade and clinical course. Useful to differentiate between HCC and hepatic adenoma	HCC positivity rate 10%-50%	[129]
		Expressed in HCC and in normal liver cells, but also in hepatoblastoma. useful for differential diagnosis vs cholangiocarcinoma and metastases	HCC positivity 66%-100%	[130-136]
Cytokeratins	Epithelial cells	Useful for differential diagnosis vs cholangiocarcinoma. HCC profile: CK7/CK19/CK8/CK18 = - / - / + / +	HCC positivity 76%-96%	[97,101,104,137-140]