Telomerase activity of needle-biopsied liver samples: its usefulness for diagnosis and judgment of efficacy of treatment of small hepatocellular carcinoma

Background/Aims: High values for telomerase activity in malignant tumors ha ve been reported. The clinical usefulness of measurements of telomerase act ivity as a diagnostic tool and to evaluate treatment efficacy in small hepa tocellular carcinoma was investigated, Methods: We investigated 22 patients (26 nodules) with intrahepatic abnorma l nodules less than or equal to 20 mm in size determined by abdominal ultra sound. All underwent needle biopsies of tumorous nodules and extranodular r egions of the liver by ultrasound guidance for histopathological diagnosis and measurement of telomerase activity by the fluorescence-based telomeric repeat amplification protocol. Re-biopsy of the same nodule was performed 1 week after percutaneous ethanol injection therapy to measure telomerase ac tivity in 10 patients (10 nodules) found to have hepatocellular carcinoma, Liver-biopsied samples from 30 patients with chronic hepatitis C were used as a control. Results: Telomerase activity increased with statistical significance stepwi se: chronic hepatitis (n = 30, mean: 0.00 U) extranodular regions (pre-cirr hosis or cirrhosis, n = 22, mean: 1.80 U), atypical hyperplasia (borderline or premalignant lesions, n = 15, mean: 7.02 U) and low-grade malignant hep atocellular carcinoma (n = 11, mean: 31.96 U) (p < 0,0001 by the Kruskal-Wa llis test), Percutaneous ethanol injection therapy resulted in loss (0.00 U ) of telomerase activity in 9 nodules and persistence in 1 nodule, Conclusions: Measurement of telomerase activity appeared useful for diagnos is of intrahepatic abnormal nodules and assessment of the efficacy of percu taneous ethanol injection therapy and may be used as an alternative diagnos tic method, especially when pathohistological discrimination between atypic al hyperplasia and well-differentiated hepatocellular carcinoma is difficul t.