Diagnosis Of Primary Hepatic Carcinoma Research Articles

Diagnostic efficacy of contrast-enhanced ultrasound, dynamic contrast-enhanced MRI combined with tumor markers AFP and DCP for primary hepatocellular carcinoma

ABSTRACT The purpose of this study was to investigate the diagnostic efficacy of contrast-enhanced ultrasound (CEUS) and dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with tumor markers alpha-fetoprotein (AFP) and des-γ-carboxyl prothrombin (DCP) for primary hepatic carcinoma (PHC). A total of 70 patients with PHC (PHC group), 42 patients with liver cyst (benign liver disease group (BLDG)) and 30 healthy people (healthy group (HG)) were selected as the research objects. CEUS and DCE-MRI were performed by American GE Vivid E9 color Doppler ultrasound system and Siemens 1.5T magnetic resonance imager, respectively. The levels of AFP and DCP were detected by ABBOTT i2000SR chemiluminescence instrument and enzyme-linked immunoassay (ELISA), respectively. In DCE-MRI examination, the portal phase and prolonged phase were mostly low signal in T1-weighted imaging (T1WI) sequence, and arterial phase was mostly high signal in T2WI sequence. In CEUS, most lesions showed hyper-enhancement in arterial phase, and hypo-enhancement in portal phase and delayed phase. AFP and DCP levels in PHC group were significantly higher than that in BLDG group and HG group. There were statistically significant differences among the three groups. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of combined diagnosis were statistically significant when compared with CEUS, AFP and DCP alone and either AFP or DCP positive. CEUS, DCE-MRI combined with tumor markers AFP and DCP have high sensitivity, specificity and accuracy in the diagnosis of PHC, which can more accurately diagnose the lesion type, provide basis for further treatment, and is worthy of clinical application.

Clinical Value Study on Contrast-Enhanced Ultrasound Combined with Enhanced CT in Early Diagnosis of Primary Hepatic Carcinoma.

Objective To explore the clinical value of contrast-enhanced ultrasound combined with enhanced CT in the early diagnosis of primary hepatic carcinoma (PHC). Methods 84 patients with suspected PHC in the early stage treated in our hospital from January 2020 to January 2022 were selected as the study subjects. All patients underwent contrast-enhanced ultrasound and enhanced CT examinations, and the surgery was performed for resection of lesions within 1 month. According to the results of postoperative pathology diagnosis, the benign group and the malignant group were included. The case data were viewed for the retrospective study to analyze the clinical application value by evaluating the diagnostic efficiency of contrast-enhanced ultrasound, enhanced CT, and their combination for PHC. Results Among 84 suspected patients, 70 patients had PHC (malignant group) and 14 patients had other hepatic lesions (benign group) after postoperative histopathological examination. There was no significant difference in age, gender, clinical symptoms, and educational level between the two groups (P > 0.05), with obvious differences in the history of chronic hepatic disease, smoking, drinking, and infection of hepatitis B virus (HBV) between the two groups (P < 0.05). The enhancement time and regression time of the two groups were significantly different (P < 0.05), with no statistical difference in the enhancement pattern of photography (P > 0.05). For patients with PHC, the imaging features of the two inspection methods at arterial phase and lag phase were statistically different (P < 0.05). Taking pathologic findings as the gold standard, the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of joint diagnosis were significantly higher than those of contrast-enhanced ultrasound and enhanced CT (P < 0.05), and the area under the curve of joint diagnosis was obviously larger than that of contrast-enhanced ultrasound and enhanced CT by placing the ROC curve for examination (P < 0.05). Conclusion The combination of contrast-enhanced ultrasound and enhanced CT has a higher accuracy in the early diagnosis of PHC, and the diagnostic efficiency of contrast-enhanced ultrasound is higher than that of enhanced CT. In clinical practice, the physical condition and state of illness in patients should be fully considered, and the most suitable examination method should be selected to reduce their medical burden by taking into account their economic situation.

Aptamer-Based Triple Serum Fluorescence Intensity Assay: A Novel and Feasible Method for the Clinical Diagnosis of Primary Hepatic Carcinoma

Background and AimsAptamers are artificial ligands that bind to biological targets with high specificity and affinity. We previously selected a group of aptamers against the serum of primary hepatic carcinoma (PHC) via systematic evolution of ligands by exponential and enrichment (SELEX) method, and some of the aptamers were valuable for PHC diagnosis in polyacrylamide gel electrophoresis (PAGE) analysis. Here, we used aptamers to develop a novel method suitable for the clinical diagnosis of PHC.MethodsThe intensities of serum autofluorescence, cell-free DNA (cfDNA)-related fluorescence and aptamer-related fluorescence, named the aptamer-based triple serum fluorescence intensity (ATSFI), were sequentially measured at 8 °C and 37 °C in one tube by using a real-time polymerase chain reaction (PCR) system as a fluorimeter in patients with PHC (n=346) or liver cirrhosis (n=321). The diagnostic performances of ATSFI indicators alone and in combination were evaluated by area under the receiver operator characteristic curve (AUROC), and the underlying clinical mechanisms were analyzed by bivariate correlation.ResultsThe measurement of ATSFI was high throughput, rapid, convenient, and low cost. The aptamer-related fluorescence indicator SEA-SE37 was the most valuable for PHC diagnosis among all fluorescence indicators and superior to alpha-fetoprotein (AFP) (AUROC 0.879 vs. 0.836). The logistic model of ATSFI indicators exhibited excellent diagnostic performance for PHC, including AFP-negative, early and small PHCs, with AUROCs of 0.935-0.950 and accuracies of 86.8-88.3%. The diagnostic performance was further improved when ATSFI indicators were combined with AFP, with AUROCs of approximately 0.95 and accuracies of approximately 90%, suggesting ATSFI was independent of but complementary to AFP in PHC diagnosis. ATSFI models were highly valuable in clinical decision-making. The aptamer-related fluorescence intensity was generally independent of the clinicopathological characteristics of PHC but correlated with laboratory characteristics of PHC serum.ConclusionsThe ATSFI assay is a novel, robust and feasible method for the clinical diagnosis of PHC.

Efficacy Evaluation on the Color Doppler Ultrasound, Multislice Spiral CT Combined with Serum Markers in Diagnosis of Primary Hepatic Carcinoma.

Background:The efficacy of color Doppler ultrasound, multislice spiral CT combined with serum alpha-fetoprotein (AFP) and alpha-fetoprotein heterogeneity (AFP-L3) in the diagnosis of primary hepatic carcinoma was evaluated.Methods:Seventy-nine patients with primary hepatic carcinoma (PHC group) and 50 patients with benign liver lesions (benign control group) admitted in Yantaishan Hospital (Yantai, China) from January 2016 to December 2018 were selected. The liver was scanned by color Doppler ultrasound and multiple multislice spiral CT. The serum AFP and AFP-L3 levels were detected by electrochemiluminescence. The value of color Doppler ultrasound, multislice spiral CT combined with serum AFP and AFP-L3 in diagnosis of primary liver cancer was retrospectively analyzed.Results:The color Doppler flow imaging (CDFI) showed a high-speed and high-resistance spectrum. The serum AFP and AFP-L3 levels of patients with primary hepatic carcinoma were significantly higher than those of the benign control group were (U=138.000 and 155.500, P=0.000 and 0.000), P<0.01. The sensitivity, accuracy and negative predictive value of color Doppler ultrasound, multislice spiral CT combined with serum AFP and AFP-L3 examinations for diagnosis of primary hepatic carcinoma were 96.20, 90.70 and 93.18%, which was significantly improved compared with each single examination (X2=27.888, 17.511 and 16.202, P=0.000, 0.002 and 0.003), P<0.01.Conclusion:Color Doppler ultrasound, multislice spiral CT combined with AFP and AFP-L3 examination could significantly improve the diagnosis efficiency of primary hepatic carcinoma, which was beneficial to early clinical diagnosis and early treatment.

Diagnostic value of serum alpha-fetoprotein, alpha-fetoprotein variant and abnormal prothrombin in primary hepatocellular carcinoma

Objective: To explore the diagnostic value of single or combined detection of serum tumor markers alpha-fetoprotein (AFP), α-fetoprotein (AFP)-L3 and abnormal clotting (PIVKA-II) in the primary hepatic carcinoma. Methods: Serum AFP, AFP-L3 and PIVKA-II of 56 cases with primary hepatic carcinoma, 46 cases with cirrhosis, 45 cases with other liver disease and 41 healthy persons (control group) were examined by chemiluminescence method, and the differences in the levels of AFP, AFP-L3 and PIVKA-II in each group were compared. Results: Serum level of AFP, AFP-L3 and PIVKA-II in patients with primary liver cancer was significantly higher than that of the cirrhosis, other liver disease and control groups, and the difference was statistically significant (P < 0.05). The receiver operating characteristic curve analysis showed that the areas under the curve for the diagnosis of primary hepatic carcinoma by AFP, AFP-L3 and PIVKA-II were 0.887, 0.846 and 0.885, respectively. The combined use of the three tumor markers for the diagnosis of primary hepatic carcinoma increased the area under the curve to 0.899. Among the single detection, AFP had the highest sensitivity of 91.07% and PIVKA-II had the highest specificity at 88.63%. In the combined detection, AFP/PIVKA-II combination had the highest sensitivity of 94.64 %, while the AFP + AFP-L3 + PIVKA-II combination had the highest specificity at 98.48%. Conclusion: Combined detection of AFP, AFP-L3 and PIVKA-II could improve the diagnostic specificity and the sensitivity of primary hepatic carcinoma; thereby make up the deficiency of single detection and improve the early diagnosis rate.

Value of ultrasonography in the diagnosis of primary hepatic carcinoma and thyroid carcinoma.

The present study explored the value of ultrasonography in the diagnosis of primary hepatic carcinoma (PHC) and thyroid carcinoma (TC) by assessing their sonographic features. A total of 426 patients diagnosed with liver space-occupying lesions by ultrasonic examination admitted to Liaocheng People's Hospital from March 2014 to October 2017 were enrolled in this study. These patients were divided into two groups: A total of 226 patients with 237 foci in the PHC group and 200 patients with 216 foci in the benign liver lesion group. During the same period, 367 patients diagnosed with thyroid nodules (382 nodules) by ultrasonic examination were also enrolled in this study. These patients were divided into further two groups: A total of 193 patients with 203 nodules in the TC group and 174 patients with 179 nodules in the benign thyroid nodule group. Two-dimensional and color Doppler ultrasonography were performed on all the patients in the four groups. Differences in the sonographic features such as focus morphology, focus size, internal echo, halo and blood flow distribution were statistically significant between patients in the PHC and the benign liver lesion group (p<0.001). Differences in the sonographic features such as nodule boundary, nodule size, internal echo, microcalcification, lymph node status and blood flow were statistically significant between patients in the TC and the benign thyroid nodule group (p<0.01). PHC can be differentiated from benign liver lesions by evaluation of focus morphology, focus size, internal echo, halo, and blood flow. TC can be differentiated from benign thyroid nodules by evaluation of nodule boundary, nodule size, internal echo, microcalcification, lymph node status, and blood flow. Ultrasonic diagnosis of PHC and TC is not only accurate, but also convenient, fast, cost-efficient and non-invasive. Thus, application of ultrasonography in the diagnosis of PHC and TC should be expanded for the benefits of patients.

A study on the value of 10 tumor markers in diagnosis of primary hepatic carcinoma

A study on the value of 10 tumor markers in diagnosis of primary hepatic carcinoma

The significance of autoantibodies detection for the diagnosis of primary hepatic carcinoma

Primary hepatic carcinoma is one of the most common cancer in China. There is no accurate and reliable serological diagnostic method could be used for the early diagnosis and prognosis evaluation of primary hepatic carcinoma at present. The detection of autoantibody for tumor associated antigens has high sensitivity and specificity to diagnose cancer. Thus, measurement of autoantibodies of primary hepatic carcinoma is expected to achieve early diagnosis and prognosis evaluation. The research situation and application prospect of these biomarkers are summarized.(Chin J Lab Med, 2016, 39: 76-78) Key words: Liver Neoplasms; Autoantibodies; Antigens, Neoplasm; Early Diagnosis; Prognosis

Application of Different Imaging Methods in the Early Diagnosis of Primary Hepatic Carcinoma.

Primary hepatic carcinoma (PHC) is the one of the most common tumors and the common cause of cancer death in the world. Detecting PHC in its early stage by imaging methods may greatly increase survival rates of patients. Ultrasound, computed tomography, magnetic resonance imaging, and positron emission tomography/computed tomography are common imaging methods in the diagnosis of PHC. In this paper, the application of different imaging methods in diagnosing the primary hepatic carcinoma will be discussed.

Diagnosis value of combined detection of serum golgi protein 73, desgamma carboxy prothrombin and α-fetoprotein in primary hepatic carcinoma

To analyze the clinical value of the detection of serum desgamma carboxy prothrombin (DCP), golgi glycoprotein 73 (GP73), heat-shock protein 70 (HSP70) in primary hepatic carcinoma (PHC) diagnosis. Enzyme-1inked immunosorbent assay and electrochemiluminescence immunoassay were used to detect the serum DCP, GP73, HSP70 and α-fetoprotein (AFP) levels in 35 PHC patients and 35 healthy controls. AFP, DCP and GP73 levels in PHC patients were 13.780 (1.140-8 487.000)µg/L, 3 213.953 (2.510-53 994.602)pg/ml and 76.838 (24.500-232.875)ng/ml respectively, significantly higher than those in healthy controls (1.240 (0.605-5.310)µg/L, 104.610 (0.000-4 138.770)pg/ml and 30.770 (16.343-87.453)ng/ml, U value were 134.50, 258.00 and 168.00, all P < 0.01); HSP70 could not be detected in any objects. The area under the ROC curve of DCP or GP73 was 0.789, 0.863 respectively. The sensitivity and specificity to PHC diagnosis were 54.3% and 97.1% by DCP (2 939.4 pg/ml as cut-off value), 85.7% and 74.3% by GP73 (41.3 ng/ml as cut-off value), 45.7% and 100% by AFP (20 µg/L as cut-off value). In combined detection the sensitivity, specificity and accuracy were 88.6%, 74.3%, 81.4% by GP73/AFP and 91.4%, 71.4%, 81.4% by GP73/DCP/AFP. GP73, DCP are new effective markers in the diagnosis of PHC, and the combined detection of GP73, DCP and AFP can improve the diagnosis value of PHC.

Inferior vena cava thrombus

Summary Background: The inferior vena cava (IVC) thrombus is an entity with many different causes and clinical presentations. Methods: In the past five years, we treated 16 patients with IVC thrombus and a diagnosis of primary hepatic carcinoma in 6 (37.5%), metastatic hepatic carcinoma in 8 (50%), and Budd-Chiari syndrome in 2 patients (12.5%). Results: Conservative treatment with enhanced immunotherapy, chemotherapy, and transcatheter arterial chemoembolization for the hepatic malignancies led to an overall survial of 82.2% at 16-month follow-up. Discussion: The prognosis of IVC tumor thrombus is usually poor and the surgical techniques are quite challenging. Surgical re-section combined with chemotherapy for advanced hepatocellular carcinoma with tumor thrombus has led to promising results. Aggressive radical nephrectomy with IVC thrombectomy remains the most effective therapeutic option in patients with renal cell carcinoma and IVC tumor thrombus. With the development of minimally invasive surgical techniques and the avoidance of cardiopulmonary bypass, less trauma and prolonged survival can be expected for IVC thrombus of malignant etiology.

Expression of miRNA-29b and its clinical significances in primary hepatic carcinoma

To explore the clinical value of miRNA-29b expression and the combined detection of serum miRNA-29b and alpha-fetoprotein (AFP) in the diagnosis of primary hepatic carcinoma(PHC). From January 2007 to May 2010, the serum levels of miRNA-29b and AFP from 96 healthy controls and 87 PHC patients were measured by quantitative reverse transcription-polymerase chain reaction (qRT-PCR) and enzyme-linked immunosorbent assay (ELISA) respectively. The relationship of miRNA-29b and various clinical parameters was analyzed. Serum levels of miRNA-29b in PHC pre-operative group (0.250 (0.124 - 0.381)) significantly decreased versus the control group [0.860 (0.587 - 1.338)] and the post-operative group (0.890 (0.637 - 1.414)) (P < 0.001). Also, the levels of AFP in PHC pre-operative group (65.4 (20.1 - 212.3)) was obviously higher than that in the control group (13.3 (7.1 - 19.8)) and the post-operative group (23.2 (11.6 - 55.7)) (P < 0.001). A lower expression of miRNA-29b was correlated with lower differentiation and higher TNM stages (P < 0.045, P < 0.001). Kaplan-Meier curve analysis revealed that PHC patients with a low serum expression of miRNA-29b had a significantly shortened overall survival when compared with a high serum expression of miRNA-29b (25.52 vs 36.94 months, P = 0.008). Multivariable Cox regression analysis indicated that the serum expression of miRNA-29b was an independent risk factor for overall survival. Relative risk was 0.482 (95% confidence interval: 0.236 - 0.985). The critical values for miRNA-29b and AFP were determined at 0.38 and 23.1 µg/L through the ROC curves. Under the critical value, the sensitivity of miRNA-29b and AFP were 75.9% and 70.1% and the specificity of miRNA-29b and AFP 89.5% and 92.7% respectively. Combined detection could increase the sensitivity up to 87.3%, and achieve a specificity of 88.5%. The combined detection of miRNA-29b and AFP aids the diagnosis of PHC and the prediction of its prognosis.

Expression profiles and differential diagnostic value of serum Golgi protein-73 in patients with liver cirrhosis and primary hepatic carcinoma

To investigate the expression profiles of serum Golgi protein-73 (GP73) in liver cirrhosis and primary hepatic carcinoma (PHC) and determine its clinical value for differential diagnosis. Serum protein expressions of GP73 and alpha-fetoprotein (AFP) were detected by enzyme-linked immunosorbent assay and chemiluminescence assay, respectively, in patients with PHC (n=80), liver cirrhosis (n=65), and healthy controls (n=50). Inter-group changes were assessed by Kruskal-Wallis test, and significance of these differences was assessed by Mann-Whitney test. A receiver operating characteristic (ROC) curve was plotted to evaluate the diagnostic efficiency and determine the cut-off values for GP73 and AFP. Sensitivity and specificity were compared by the Chi-squared test. Correlation between serum GP73 expression and clinical parameters was determined by Spearman's rank correlation analysis. The PHC group showed significantly higher serum GP73 (282.0 mug/L) than the liver cirrhosis group (211.8 mug/L) and control group (58.3 mug/L) (H = 93.30, P less than 0.01). For differential diagnosis of PHC and liver cirrhosis, the cut-off value was 318.1 mug/L for GP73 and 13.4 mug/L for AFP. Sensitivity of GP73 was lower than AFP (45% (36/80) vs. 65% (52/80); X2 = 8.02, P less than 0.05). Specificity of GP73 was lower than AFP but no significance was found (83.1% (54/65) vs. 87.7% (57/65); X2=0.27, P more than 0.05). The areas under the ROC curves were not significantly different between GP73 and AFP (0.65 (95% confidence interval (CI): 0.54~0.72) vs. 0.75 (95% CI: 0.67~0.83); Z = 1.88, P more than 0.05). The area under the ROC curves increased but not significantly (0.80 (95% CI: 0.73~0.88) vs. 0.75 (95% CI: 0.67~0.83); Z=2.61, P more than 0.05). Serum GP73 was correlated with liver cirrhosis (r=0.27), vascular invasion (r=0.29), and TNM staging (r=0.27) (all P less than 0.05), but not with sex (r=0.13), age (r=0.10), enhanced AFP (> 13.4 mug/L; r=0.03), tumor size (r=0.18), or distant metastasis (r=0.04), all P less than 0.05. Serum GP73 and AFP have comparable diagnostic efficiency, but the sensitivity of AFP is superior for differential diagnosis of liver cirrhosis and primary hepatic carcinoma. Elevated serum GP73 may be correlated with liver tumor load and aggressiveness.

Quantum dot-based immunochromatography test strip for rapid, quantitative and sensitive detection of alpha fetoprotein

Rapid, quantitative detection of tumor markers with high sensitivity and specificity is critical to clinical diagnosis and treatment of cancer. We describe here a novel portable fluorescent biosensor that integrates quantum dot (QD) with an immunochromatography test strip (ICTS) and a home-made test strip reader for detection of tumor markers in human serum. Alpha fetoprotein (AFP), which is valuable for diagnosis of primary hepatic carcinoma, is used as a model tumor marker to demonstrate the performance of the proposed immunosensor. The principle of this sensor is on the basis of a sandwich immunoreaction that was performed on an ICTS. The fluorescence intensity of captured QD labels on the test line and control line served as signals was determined by the home-made test strip reader. The strong luminescence and robust photostability of QDs combined with the promising advantages of an ICTS and sensitive detection with the test strip reader result in good performance. Under optimal conditions, this biosensor is capable of detecting as low as 1 ng/mL AFP standard analyte in 10 min with only 50 μL sample volume. Furthermore, 1000 clinical human serum samples were tested by both the QD-based ICTS and a commercial electrochemiluminescence immunoassay AFP kit simultaneously to estimate the sensitivity, specificity and concordance of the assays. Results showed high consistency except for 24 false positive cases (false positive rate 3.92%) and 17 false negative cases (false negative rate 4.38%); the error rate was 4.10% in all. This demonstrates that the QD-based ICTS is capable of rapid, sensitive, and quantitative detection of AFP and shows a great promise for point-of-care testing of other tumor markers.

A Study of Diagnostic Value of Golgi Protein GP73 and its Genetic Assay in Primary Hepatic Carcinoma

This study aimed to investigate the diagnostic values of GP73 protein in patients' serum with primary hepatic carcinoma (PHC). Also GP73 mRNA expression level in peripheral blood mononuclear cells (PBMCs) and liver tissue between health controls and PHC patients was interrogated. Finally the role of combined detection of serum GP73 and alpha-fetoprotein (AFP) in high-risk population screening was evaluate, in an attempt to justify the new, sensitive, specific and rapid measure for the diagnosis and detection of PHC. Serum proteins of GP73 and AFP were examined in 73 patients with PHC, 13 patients with hepatic cirrhosis, 32 patients with hepatitis and 62 healthy subjects using enzyme-linked immunosorbent assay (ELISA). The relative expression levels of GP73 mRNA in PBMCs and liver tissues were examined by using SYBR Green quantitative reverse transcription polymerase chain reaction (RT-PCR) assay, calculated with the comparison of Cq value. In contrast to patients with cirrhosis and hepatitis, or healthy subjects, PHC patients had their serum GP73 and AFP significantly elevated (P < 0.05) while their PBMCs GP73 mRNA was not significantly different from those with cirrhosis and hepatitis, or healthy subjects (P > 0.05). The expression level of GP73 mRNA was significantly higher in PHC liver tissue than in normal liver tissue. The sensitivity for serum GP73 and AFP in PHC was 68.5% and 28.8%, respectively while that for the combined detection was up to 74%, justifying that the combined detection could prevent the false negative diagnosis by AFP alone and significantly improve the detection rate. As a new diagnostic biomarker of PHC, GP73 protein in serum was highly sensitive and specific. GP73 mRNA in PHC liver tissue specimens instead of whole blood could be used for the diagnosis of PHC as a tumor biomarker, whose detection was highly invasive, risky and afflicting otherwise. The combined detection of GP73 and AFP in serum effectively improved the diagnosis of PHC, in addition to the screening in high-risk population.

Clinical value of combined detection of AFP, CA125, CA199 and CEA in the diagnosis of primary hepatic carcinoma

Objective To study the clinical value of combined detection of the serum levels of AFP, CA125, CA199 and CEA in the diagnosis of primary hepatic carcinoma (PHC). Methods Serum levels of AFP, CA125, CA199 and CEA in 68 patients with PHC, 50 patients with benign liver disease and 58 normal controls were measured by Electrochemiluminescence immuno-assay (ECLIA). Results The levels of AFP, CA125, CA199 and CEA in PHC group were significantly higher than those in benign liver disease and normal controls. Sensitivities of AFP, CA125, CA199 and CEA were 76.4 %, 35.3 %, 44.1%, 29.4 %, respectively. Sensitivity of combined detection of four kinds tumor markets was 94.1%. Conclusion Combined detection of four kinds of serum tumor markers is useful to increase the detective positive rate in the diagnosis of PHC. Key words: Liver neoplasms; Radioimmunoassay; Serologic tests

Serum alpha-L-fucosidase: a new marker for the diagnosis of primary hepatic carcinoma?

alpha-L-fucosidase, a lysosomal enzyme which catabolizes fucoproteins, was studied in sera from 30 controls, 32 patients with primary hepatic carcinomas, 24 patients with secondary metastatic liver carcinomas and 36 patients with cirrhosis. Serum alpha-L-fucosidase was increased in primary hepatic carcinomas (145.5 +/- 12 nkat per liter) with a high statistical significance versus controls (51.4 +/- 4.5 - p less than 10(-7], secondary metastatic liver carcinomas (58.9 +/- 6.4 - p less than 10(-5] and cirrhotics (71.3 +/- 6 - p less than 10(-5). A level exceeding 110 was a useful marker for the diagnosis of primary hepatic carcinoma with 75% sensitivity and 90% specificity.

RADIOISOTOPE SCANNING IN PRIMARY CARCINOMA OF THE LIVER.

Characteristically, primary hepatic carcinoma remains undetected until advanced. This occultness results primarily from an absence of distinctive clinical features and from the inaccessibility of the liver. Concealment is augmented, in all probability, by a low index of clinical suspicion because of the rarity of the neoplasm in this country. The difficulty in establishing the diagnosis of primary carcinoma of the liver is illustrated by the recent report of Patton and Horn, in which 42 of 60 proved cases remained undiagnosed until autopsy (8). Clinical findings that may be associated with primary hepatic carcinoma include painful hepatomegaly, a palpable hepatic mass, jaundice, and portal hypertension with ascites (frequently sanguineous). The stigmata of cirrhosis, particularly the postnecrotic type, may be present although cirrhosis itself is absent in 25 to 60 per cent of the cases (5). Radiographic findings are nonspecific reflections of hepatomegaly and/or portal hypertension if present (3); however, the demonstration of elevation of the right diaphragm and of esophageal varices should suggest the possibility of primary hepatic carcinoma (10). No distinctive pattern of hepatic functional abnormality has been observed. Since 1954, radioisotope scanning of the liver has provided an atraumatic method for effectively visualizing the liver and mass lesions within it. Its clinical usefulness in detecting and following many forms of hepatic disease has been summarized (2, 11), but its application to the diagnosis of primary hepatic carcinoma has received scant attention in the American literature. Accordingly, it was decided to present the results of radioisotope scanning in primary liver carcinoma at the Columbia-Presbyterian Medical Center. Clinical Material and Methods Thirteen cases of primary hepatic carcinoma were encountered in 1,750 radioisotope scans of the liver obtained since 1960. The diagnosis was established by closed or open liver biopsy (6 cases) or autopsy (7 cases.) The patients ranged in age from five months to seventy-one years ; 10 were male. Postnecrotic cirrhosis was present in 3 cases, and nutritional cirrhosis, periportal fibrosis, and “early cirrhosis” in 1 case each. Radioisotope scanning was performed with a modified conventional scanner containing a collimated 3-in. NaI (Th) crystal and pulse discriminator. The radiopharmaceutical administered to each patient was colloidal gold 198 in intravenous dosage of 2.2 microcuries per kilogram of body weight. Scanning was instituted approximately twenty minutes after injection and was completed forty-five to sixty minutes later. Contrast amplification was utilized in all photoscans. Results The liver was satisfactorily outlined in the 13 patients. Concentration of radioactivity in the extrahepatic reticuloendothelial tissue was increased in 6 patients; this finding was absent in 5 and indeterminate in 2.