What are the methods for liver cancer examination

What are the methods for liver cancer examination? In recent years, the number of primary liver cancers with negative serum AFP has increased. Therefore, the development of newer, more specific and more sensitive markers has become an urgent task. Finding isoenzymes and isoplasms with carcinoembryonic characteristics and finding specific subcomponents are the current research directions of liver cancer serum markers. In recent years, the following have been reported to be of high value in liver cancer diagnosis:

① r-GT isoenzyme (GGTⅡ): Polyacrylamide gradient electrophoresis can show 12 isoenzyme bands. Bands Ⅰ, Ⅱ, and Ⅱ are specific bands for primary liver cancer, with a positive rate of 79.7%. The positive rate of this enzyme in AFP-negative patients is 72.7%.

② Alpha-fetoprotein heterogeneity (FucAFP): Currently, the diagnostic value of AFP heterogeneity determined by lentil agglutinin (LCA) affinity cross-immunoautography is high. There are two heterogeneities, namely LCA non-binding type (AFP-NL) and binding type (AFP-RL). Liver cancer contains an average of 49.13±27.20% (0-100%) of AFP-NL, and <75% is the diagnostic standard for liver cancer. The positive rate is 86.0%, which decreases as the disease worsens. The AFP-NL of non-cancerous liver disease is 93.30±7.66%, and the false positive rate is 1.6%.

③ Abnormal prothrombin: The liver synthesizes an inactive precursor of prothrombin, which is carboxylated to an active form by vitamin K, r. In liver cancer, the vitamin K-dependent carboxylation system in the microsomes of liver cancer cells is dysfunctional, the activity of hydroxylase decreases, causing incomplete glutamate carboxylation, thereby forming abnormal prothrombin. Recently, people have discovered that liver cancer cells have the ability to synthesize and release abnormal prothrombin. In China, the standard for determining abnormal prothrombin by radioimmunoautography is ≥250μg/L. The positive rate for liver cancer is 69.4%, the positive rates for low-concentration AFP and AFP-negative liver cancer are 68.3% and 65.55, respectively, and the compliance rate for small liver cancer is 62.25%. Most data show that abnormal prothrombin has a high specificity for primary liver cancer, and the false positive rate for various non-cancerous liver diseases, secondary liver cancer and benign liver tumors is extremely low, which may become a valuable liver cancer marker.

④ Serum fucosidase (AFu): AFu belongs to the lysosomal acid hydrolase class, and its main physiological function is to participate in the degradation of bioactive macromolecules such as fucosylated glycoproteins and glycolipids. Primary liver cancer should be considered when AFu exceeds 110Kat/L. Domestic reports show that the positive rate of AFu in diagnosing primary liver cancer is 81.2%, and the positive rates for AFP-negative liver cancer and small liver cancer are 76.1% and 70.8% respectively. Secondary liver cancer and benign liver space-occupying lesions are all negative, but the false positive rate of cirrhosis and chronic hepatitis is high.

⑤ M2-type pyruvate kinase (M2-PyK): Pyruvate kinase (PyK) is a key enzyme in glycolysis. There are four isoenzymes, L, R, M1M2 (k). M2 (K) is the main isoenzyme in fetal liver and liver cancer tissues, which can be regarded as a carcinoembryonic protein. The ELIS sandwich method can detect Pg-level trace amounts of cancer markers with high sensitivity. The normal value is 575.8±259.5ng/L. Liver cancer is 5 times higher than normal, and it is significantly increased in the small liver cancer stage. The poorer the differentiation, the more obvious the M2-PyK value. The positive rate is 5.25%, and it can also be increased in digestive tract tumors, but not in hepatitis and benign liver tumors.

⑥ Isoferritin (AIF): Isoferritin has a certain significance in the diagnosis of liver cancer because the synthesis of liver cancer cells increases and the release rate accelerates. The normal value is 16-210μg/L, with 300μg/L as the diagnostic threshold. 72.1% of liver cancer patients exceed this value, and the false positive rate is 10.3%. The positive rate of AFP-negative or low-concentration liver cancer is 66.6%, and the positive rate of small liver cancer <5cm is 62.5%.

⑦α-Antitrypsin (AAT): Human liver cancer cells have the function of synthesizing and secreting AAT, which increases when the tumor is combined with cell necrosis and inflammation. The immunoperoxidase technology shows that 74.9% of liver cancer patients have a level higher than 4000ng/L, while that of benign liver disease is 3-10.9%. The positive rate of AFP-negative liver cancer is 22.7%.

⑧Aldolase isoenzyme A (ALD-A): When ALD-A appears and increases to >800ng/ml in liver cancer, it is helpful for diagnosis. The positive rate of AFP-negative liver cancer is 73.65%.

In summary, the above liver cancer markers have auxiliary significance for the diagnosis of primary liver cancer, especially AFP-negative cases, but they still cannot replace the position of AFP in the diagnosis of liver cancer. According to practical experience, combined detection is better than single detection. The serum AFP test combined with 1-2 liver cancer markers can significantly increase the positive detection rate of primary liver cancer. In clinical analysis, comprehensive judgment should be made in combination with medical history, imaging diagnosis or histological data to draw accurate conclusions.