Hepatocellular carcinoma: Understanding molecular mechanisms for defining potential clinical modalities

Table 1 Utility and detection limits of existing diagnostic measures of hepatocellular carcinoma

Diagnostic methods	Definition/concept	Diagnostic limit/range	Ref.
Contrast-enhanced ultrasound	Inexpensive, non-invasive, first choice for screening HCC; Real time dynamic of blood supply.	Small HCC less than 1 cm	[101]
Multi phasic enhanced computed tomography	3 dimensional reconstructions, high sensitivity	1-2 cm HCC lesion	[102]
Magnetic resonance imaging	High resolution anatomic details, pre-contrast and multi-phasic enhanced 3D; Diffusion weighted imaging-functional imaging	2-3 cm HCC lesion	[103]
Positron emission tomography	Hepatocyte-specific PET tracer, 2-[18F] fluoro-2-deoxy-D-galactose, is used which accumulates in the liver compared with other tissues	Detection of small intrahepatic; HCC lesions	[104]
AFP	Elevated in HCC, non-specific	Range: > 500 ng/mL	[23]
α-L-fucosidase	Expressed in liver cirrhosis	Cut-off: 870 nmol/L	[105]
Des-γ-carboxy prothrombin	Sensitive; Not expressed in other liver disease	Cut-off: 40 mAU/mL	[105,106]
HSP90α + AFP +TKI	Combination of markers have improved diagnostic value	HSP90- (76.65-144.00); AFP- (5.33-2000.00); TK1- (0.57-2.30)	[26]
AFP, GPC3, and GP73	Useful markers for early diagnosis and prognosis	Upregulated	[27,107]
microRNA: miR-21, miR-199, and miR-122, miR-23a	Specific for diagnosis of HCC; Extremely sensitive	Cut-off value of ≥ 210	[108,109]

HCC: Hepatocellular carcinoma; AFP: α-fetoprotein.