Liver Biopsy for Hepatocellular Carcinoma (HCC): Should this be a Routine?

Modern ultrasound techniques for diagnosing liver steatosis and fibrosis: A systematic review with a focus on biopsy comparison

BACKGROUND

This review evaluated the diagnostic effectiveness of various ultrasound (US) methods compared to liver biopsy.

AIM

To determine the diagnostic accuracy of US techniques in assessing liver fibrosis and steatosis in adults, using the area under the receiver operating characteristic curve (AUROC) as the standard measure.

METHODS

The review included original retrospective or prospective studies published in the last three years in peer-reviewed medical journals, that reported AUROC values. Studies were identified through PubMed searches on January 3 and April 30, 2024. Quality was assessed using the QUADAS-2 tool. Results were tabulated according to the diagnostic method and the type of liver pathology.

RESULTS

The review included 52 studies. For liver fibrosis detection, 2D-shear wave elastography (SWE) AUROCs ranged from 0.54 to 0.994, showing better accuracy for advanced stages. Modifications, including 2D-SWE with propagation map guidance and supersonic imagine achieved AUROCs of 0.84 to nearly 1.0. point SWE and classical SWE had AUROCs of 0.741-0.99, and 0.507-0.995, respectively. Transient elastography (TE), visual TE, vibration-controlled TE (VCTE), and FibroTouch reported AUROCs close to 1.0. For steatosis, VCTE with controlled attenuation parameter showed AUROCs up to 0.89 (for ≥ S1), acoustic radiation force impulse ranged from 0.762 to 0.784, US attenuation parameter from 0.88 to 0.93, and normalized local variance measurement from 0.583 to 0.875. Most studies had a low risk of bias across all or most domains, but evidence was limited by variability in study quality and small sample sizes. Innovative SWE variants were evaluated in a single study.

CONCLUSION

Modern US techniques can serve as effective noninvasive diagnostic tools for liver fibrosis and steatosis, with the potential to reduce the reliance on biopsies.

Association between serum midkine levels and tumor size in Indonesian hepatocellular carcinoma patients: a cross-sectional study

Background: The incidence of liver cancer is increased worldwide with 75%–85% are diagnosed as hepatocellular carcinoma (HCC). Current practice has low sensitivity limitations to diagnose the early stages of HCC, thus urging the need for a biomarker with higher sensitivity to detect HCC, specifically in the early stage. This study aimed to determine the association between Midkine levels and progressiveness of hepatocellular carcinoma (HCC), according to tumor size, Barcelona Clinic Liver Cancer (BCLC), and presence of portal venous thrombosis.

Methods: This cross-sectional study involved 100 patients in Adam Malik General Hospital diagnosed with HCC, collected with a consecutive sampling method, whose diagnosis were confirmed by findings of hypervascular on arterial phase imaging and portal vein or delayed phase washout triple-phase CT Scan. Samples are later categorized according to Barcelona Clinic Liver Cancer (BCLC) stages, tumor size, and presence of portal venous thrombosis. Blood samples were drawn to measure serum Midkine using ELISA. Kruskal-Wallis and Mann-Whitney U tests were conducted to determine the difference of Midkine levels based on tumor size, BCLC staging, and presence of portal venous thrombosis.

Results: Serum Midkine level shows a significant difference over tumor size (p=0.014), no significant difference found compared to BCLC stages and presence of portal venous thrombosis.

Conclusion: Serum Midkine levels are associated with the tumor size of HCC, thus helping physicians determine treatment plans.

Non-viral gene delivery of the oncotoxic protein NS1 for treatment of hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is related to increasing incidence rates and poor clinical outcomes due to lack of efficient treatment options and emerging resistance mechanisms. The aim of the present study is to exploit a non-viral gene therapy enabling the expression of the parvovirus-derived oncotoxic protein NS1 in HCC. This anticancer protein interacts with different cellular kinases mediating a multimodal host-cell death. Lipoplexes (LPX) designed to deliver a DNA expression plasmid encoding NS1 are characterized using a comprehensive set of in vitro assays. The mechanisms of cell death induction are assessed and phosphoinositide-dependent kinase 1 (PDK1) is identified as a potential predictive biomarker for a NS1-LPX-based gene therapy. In an HCC xenograft mouse model, NS1-LPX therapeutic approach results in a significant reduction in tumor growth and extended survival. Data provide convincing evidence for future studies using a targeted NS1 gene therapy for PDK1 overexpressing HCC.

Integration of transcriptomes analysis with spectral signature of total RNA for generation of affordable remote sensing of Hepatocellular carcinoma in serum clinical specimens

Hepatocellular carcinoma (HCC) is a major global health problem with about 841,000 new cases and 782,000 deaths annually, due to lacking early biomarker/s, and centralized diagnosis. Transcriptomes research despite its infancy has proved excellence in its implementation in identifying a coherent specific cancer RNAs differential expression. However, results are sometimes overlapped by other cancer types which negatively affecting specificity, plus the high cost of the equipment used. Hyperspectral imaging (HSI) is an advanced tool with unique, spectroscopic features, is an emerging tool that has widely been used in cancer detection. Herein, a pilot study has been performed for HCC diagnosis, by exploiting HIS properties and the analysis of the transcriptome for the development of non-invasive remote HCC sensing. HSI data cube images of the sera extracted total RNA have been analyzed in HCC, normal subject, liver benign tumor, and chronic HCV with cirrhotic/non-cirrhotic liver groups. Data analyses have revealed a specific spectral signature for all groups and can be easily discriminated; at the computed optimum wavelength. Moreover, we have developed a simple setup based on a commercial laser pointer for sample illumination and a Smartphone CCD camera, with HSI consistent data output. We hypothesized that RNA differential expression and its spatial organization/folding are the key players in the obtained spectral signatures. To the best of our knowledge, we are the first to use HSI for sensing cancer based on total RNA in serum, using a Smartphone CCD camera/laser pointer. The proposed biosensor is simple, rapid (2 min), and affordable with specificity and sensitivity of more than 98% and high accuracy.