Published online May 15, 2019. doi: 10.4251/wjgo.v11.i5.404
Peer-review started: January 16, 2019
First decision: March 14, 2019
Revised: March 29, 2019
Accepted: April 19, 2019
Article in press: April 19, 2019
Published online: May 15, 2019
Pathological manifestations of hepatic tumours are often associated with prognosis. Although surgical specimens (SS) can provide more information, currently, pre-treatment needle core biopsy (NCB) is increasingly showing important value in understanding the nature of liver tumors and even in diagnosis and treatment decisions. However, the concordance of the clinicopathological characteristics and immunohistochemical (IHC) staining between NCB and SS from patients with hepatic tumours were less concerned.
The present study was designed to evaluate the concordance of the clinicopathological characteristics and the novel biotic marker of CK19, GPC3, and HepPar1 staining between the NCB and SS from patients with hepatocellular carcinoma (HCC) or intrahepatic cho-langiocarcinoma (ICC).
We want to introduce a more accurate method for interpreting the immunohistochemical staining results to improve the diagnostic value of hepatic malignancy in NCB samples.
A total of 208 patients who underwent both preoperative NCB and surgical resection for HCC or ICC between 2008 and 2015 were enrolled in this study. The expression of CK19, GPC3, and HepPar1 were detected by IHC staining. Clinicopathological, NCB, and surgical data were collected and analysed using χ2 and kappa statistics.
Morphologically, the presence of compact tumour nests or a cord-like structure in NCB was considered the primary cause of misdiagnosis of HCC from ICC. The kappa statistic showed a moderate agreement in histomorphology (k = 0.504) and histological grade (k = 0.488) between NCB and SS of the tumours. A 4-tier (+++, ++, +, and -) scoring scheme that emphasized the focal neoplastic cell immunoreactivity of tumour cells revealed perfect concordance of CK19, GPC3 and HepPar1 between NCB and SS (k = 0.717; k = 0.768; k = 0.633). Furthermore, with the aid of a binary classification derived from the 4-tier score, a high concordance was achieved in interpreting the IHC staining of the three markers between NCB and final SS (k = 0.931; k = 0.907; k = 0.803), increasing the accuracy of NCB diagnosis C(k = 0.987; area under the curve = 0.997, 95%CI: 0.990-1.000; P < 0.001).
Our findings imply that reasonable interpretation of IHC staining results in NCB is vital for improving the accuracy of tumour diagnosis. The simplified binary classification provides an easy and applicable approach.
Although the binary classification can significantly improve the accuracy of diagnosis of HCC or ICC, it is unclear whether the method can be transferred to patients with other tumors. In addition, the degree of consistency of the indicators in patients with a multifocal tumor between NCB and SS necessitates further investigation, which will be the focus of our future studies.