Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. May 15, 2019; 11(5): 404-415
Published online May 15, 2019. doi: 10.4251/wjgo.v11.i5.404
Histopathological characteristics of needle core biopsy and surgical specimens from patients with solitary hepatocellular carcinoma or intrahepatic cholangiocarcinoma
Ju-Shan Wu, Ji-Liang Feng, Rui-Dong Zhu, San-Guang Liu, Da-Wei Zhao, Ning Li
Ju-Shan Wu, Rui-Dong Zhu, Ning Li, General Surgical Center, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
Ji-Liang Feng, Clinical-Pathology Center, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
San-Guang Liu, Department of Hepatobiliary Surgery, the Second Hospital, Hebei Medical University, Shijiazhuang 050000, Hebei Province, China
Da-Wei Zhao, Medical Imaging Department, Beijing You-An Hospital, Capital Medical University, Beijing 100069, China
Author contributions: Wu JS and Feng JL contributed equally to this paper and should be considered as co-first author; Wu JS, Feng JL and Li N designed and wrote this paper; Zhu RD and Liu SG collected the samples; Feng JL and Zhao DW made the pathology and statistics analysis.
Supported by The Special Scientific Research Fund for Beijing Health Development, No. 2014-2-2182; The Scientific Research Project of Beijing You’an Hospital, CCMU, No. YNKTTS20180110; and Capital Characteristic Fund, No. Z171100001017035.
Institutional review board statement: This study was approved by the Regional Ethics Committee of the hospitals.
Informed consent statement: Informed consent was obtained from all individual participants included in the study.
Conflict-of-interest statement: There is no potential conflict of interest involved in this paper.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Ning Li, MD, PhD, Professor, General Surgical Center, Beijing You-An Hospital, Capital Medical University, No. 8 Xitoutiao Outside You'anmen, Fengtai District, Beijing 100069, China.
Telephone: +86-10-83997175 Fax: +86-10-83997169
Received: January 16, 2019
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
Processing time: 119 Days and 17.9 Hours
Research background

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.

Research motivation

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).

Research objectives

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.

Research methods

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.

Research results

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).

Research conclusions

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.

Research perspectives

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.