P-38: Microvessel Density Evaluation of Hepatocellular Carcinoma Using CD34 Immunostaining


Montazer M *, Amoueian S , Attaranzadeh A , Pour Alborzi F , Tarhini M ,

0

Objective: Hepatocellular carcinoma (HCC) is one of the most common malignancies in the world. Distinguishing a well-differentiated HCC from normal and cirrhotic liver tissue or benign liver nodules can be quite challenging especially in cases of small needle core biopsies. The aim of this study was to comprehensively evaluate the microvessel density (MVD) in benign and malignant hepatic lesions by immunostaining for CD34. Materials and Methods: Twenty HCC, four chronic hepatitis, five cirrhotic livers, three normal hepatic tissues, two fatty livers, and one adenomatosis, diagnosed between 1999 and 2009 in the Pathology Department of Qhaem and Imam Reza hospitals, Mashhad University of Medical Sciences, Iran, were included in the study. Multiple 4-µm-thick sections of representative formalin-fixed, paraffin-embedded tissues were cut for immunohistochemical investigation. A Polymer-Based technique was used for the detection of CD34 (Clone QBEnd10, DakoCytomation, Glostrup, Denmark). Reactive lymph node was used as the positive control for CD34 while immunostaining without adding antibody was used as the negative control. MVD of tissues were evaluated according to the Gasparini's criteria (The Chalkley point) by two independent blinded observers. There were no statistically significant differences among observers. ROC curve analysis was performed to assess the diagnostic accuracy of MVD in detecting the HCC. Results: The mean age of patients with malignant diagnosis was 60.7 ± 15.8 years (vs. 44.3 ± 23.2 years in benign group, p=0.024). It was found that 70% of malignant cases and 68.8% of benign cases were diagnosed in male patients. MVD counts in HCC was significantly higher compared to benign hepatic lesions (129.1 ± 44.1 vs.74.0 ± 39.6; p<0.001). No statistically significant difference between mean MVD of benign and normal cases was found (47.8 ± 8.1 vs. 74.0 ± 37.4, p>0.05). Furthermore, anti-CD34 staining showed negative or incomplete patterns in nonmalignant tissues, while in all hepatocellular carcinomas complete immunostaining patterns were depicted. This difference in immunostaining patterns of benign and malignant lesions was statistically significant (p<0.001). In addition, there were no statistically significant connections between MVD and either sex or age. Sensitivity, specificity, positive predictive value and negative predictive value for MVD (cut off=101) were 0.85 (0.63-0.94), 0.82 (0.58-0.93), 0.85 (0.63-0.94) and 0.82 (0.58-0.93), respectively. Conclusion: HCC is a highly vascular The evaluation of MVD-CD34, regarding its immunostaining patterns, contributes to the reliable distinction between HCC and non-neoplastic liver diseases