CYTOMETRIC MEASUREMENT OF CELL-PROLIFERATION IN ECHO-GUIDED BIOPSIES FROM FOCAL LESIONS OF THE LIVER

Increased proliferative activity determined in surgical specimens of h epatocellular carcinoma (HCC) has been associated with tumor grade and patient survival. The measurement of cell proliferation in echo-guide biopsies of small focal liver lesions might provide useful informatio n for the early recognition of malignancy and for predicting the aggre ssiveness of small HCCs. We assessed the diagnostic and prognostic val ue of cell proliferation in 91 echo-guided needle biopsies of focal li ver lesions using the monoclonal antibody Ki-67 which detects a human nuclear antigen that is present in proliferating cells. Measurements w ere performed by image cytometry as the percentage of Ki-67 positive h epatocytes nuclei over total hepatocyte nuclei in the biopsy. At the h istological examination, 27 lesions were diagnosed as chronic hepatiti s, 10 as cirrhosis, 11 as macroregenerative nodule, and 43 as HCC in c irrhotic liver. Although the highest Ki-67 values (>20%) were found in less-differentiated HCCs, most well-differentiated HCCs and nine bord erline nodules were completely devoid of Ki-67-positive hepatocytes. A sustained Ki-67 labeling (up to 16%) was found in hepatitis and cirrh osis, similar to that found in several malignant tumors. In the HCC su bset, Ki-67 labeling was strongly correlated to the Edmondson-Steiner histological grade. However, survival-analysis did not indicate a bett er outcome for those patients with low-proliferating tumors.