Dual-parameter liquid biopsy using plasma miR-21-5p and T cell LAIR-1 mean fluorescence intensity for hepatocellular carcinoma diagnosis in a high-risk Egyptian cohort

Figure 4 Proposed sequential diagnostic algorithm for hepatocellular carcinoma detection in patients with cirrhosis. The clinical workflow leverages the complementary strengths of immune and molecular biomarkers. Step 1 employs T cell leukocyte-associated immunoglobulin-like receptor-1 (LAIR-1) with perfect sensitivity (100%); values exceeding the 293 threshold trigger immediate diagnostic imaging. Step 2 applies plasma hsa-miR-21-5p quantification to individuals negative for LAIR-1 mean fluorescence intensity (MFI), capturing residual hepatocellular carcinoma (HCC) cases. In this cohort the integrated algorithm achieved 100% sensitivity with 95.0% aggregate specificity for distinguishing HCC from cirrhosis, representing a robust strategy for improving surveillance accuracy. HCV: Hepatitis C virus.