What tests should be done to diagnose primary liver cancer? A complete list of clinical diagnostic methods for primary liver cancer

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 issue. The search for isoenzymes and isoplasms with carcinoembryonic characteristics and the search for specific subcomponents are the current research directions of serum markers for liver cancer.

The threat of primary liver cancer is obvious to all. If it is not effectively treated, it will directly endanger life and health. Early detection and diagnosis are crucial to the treatment of this disease. Therefore, early detection and examination are crucial. What are the specific methods?

1. Serology

(1) AFp: AFp is currently the most specific marker for diagnosing hepatocellular carcinoma. AFp is an embryonic protein synthesized by the liver during the fetal period, and can regain this function when adult liver cells become malignant. Since embryonic carcinoma of the gonads can also occur in pregnant women, newborns, and testicles or ovaries, AFp has only a relatively specific diagnostic value for hepatocellular carcinoma. Due to the improvement in the sensitivity of the detection method, low concentrations of AFp can also be detected in some hepatitis, cirrhosis, and a few digestive tract cancers such as gastric cancer, colon cancer, pancreatic cancer and other metastatic liver cancers. Therefore, the AFp test results must be linked to clinical practice to be diagnostically meaningful.

At present, the radioimmunoassay (RIA) or AFp monoclonal antibody enzyme immunoassay (EIA) rapid assay is mostly used to detect serum AFp content. There is no trace amount in normal human serum, less than 20μg/L. 70-90% of patients with hepatocellular carcinoma have elevated AFp levels. Usually, AFp concentration is related to tumor size, but there are large individual differences. It is generally believed that AFp is often low or undetectable in patients with pathological differentiation close to normal hepatocytes or with extremely low differentiation. The recognized standards abroad are often high and easy to miss. my country attaches importance to the dynamic observation of increased medium and low concentrations of AFp. In clinical practice, patients with low AFp concentrations often need to be followed up with imaging diagnostic technology to help establish a diagnosis early. Liver cancer often occurs on the basis of chronic active liver disease, so it must be differentiated. In chronic hepatitis and post-hepatitis cirrhosis, AFp increases in 19.9% ​​to 44.6% of patients, with concentrations mostly between 25 and 200 μg/L. Benign liver disease activity often precedes a significant increase in alanine aminotransferase, and AFp is associated or synchronized, first high and then low. Generally, within 1 to 2 months, as the condition improves, the aminotransferase decreases, and AFp decreases accordingly, showing a "transient" state. Sometimes, AFp in benign liver disease activity may also show dynamic changes such as repeated fluctuations and continuous low concentrations, but one must be alert to the possibility of early cancer while liver disease activity is present.

⑵ Detection of other liver cancer markers: 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 heteroplasms 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 the diagnosis of liver cancer:

① r-GT isoenzyme (GGTⅡ): polyacrylamide gradient electrophoresis separation method 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 is high by using lentil agglutinin (LCA) affinity cross-immunoautography. There are two heterogeneities, namely LCA non-binding type (AFp-NL) and binding type (AFp-RL). The average AFp-NL content in liver cancer is 49.13±27.20% (0-100%), and 75% is the diagnostic standard for liver cancer. The positive rate is 86.0%, which decreases with the deterioration of the disease. 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, and the activity of hydroxylase decreases, resulting in incomplete glutamate carboxylation, thereby forming abnormal prothrombin. Recently, it has been 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 liver cancer with low AFp concentration and AFp-negative liver cancer are 68.3% and 65.5%, respectively, and the compliance rate for small liver cancer is 62.2%. Most data show that abnormal prothrombin has a high specificity for primary liver cancer, and the false positive rates for various non-cancerous liver diseases, secondary liver cancer and benign liver tumors are extremely low, and it 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 negative, but the false positive rate of cirrhosis and chronic hepatitis is high.

⑤M2 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 5.2%, 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 liver cancer with negative AFp or low concentration AFp is 66.6%, and the positive rate of small liver cancer of & 5 cm 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. Immunoperoxidase technology shows that 74.9% of liver cancer cases are higher than 4000ng/L, while 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 73.6%.

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 AFp in the diagnosis of liver cancer. According to practical experience, combined detection is better than single detection. Serum AFp detection 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 combined with medical history, imaging diagnosis or histological data to draw accurate conclusions.

When your body sends out bad signals, you must go to a regular hospital for a comprehensive diagnosis so that the condition can be confirmed as soon as possible, which will be of great help in the cure of the disease. In addition, you must keep a happy mood, as mood factors have a great relationship with liver disease.