The Diagnostic Value of Serum Endoglin In Patient With Liver Cirrhosis And Hepatocellular Carcinoma

Abstract

The aim of this study was to investigate the potential role of serum endoglin as a diagnostic non invasive marker for HCC and to assess its sensitivity and specificity as a marker of HCC in patients with chronic liver disease. This study was conducted on 60 patients who were divided into two groups: HCC group included 30 patients with HCC on the background of liver cirrhosis. HCC was diagnosed by ultrasound, triphasic abdominal CT scan. Cirrhotic group included 30 patients with cirrhosis without any evidence of hepatic focal lesions as excluded by ultrasonography and AFP estimation. Cirrhotic patients will be divided according to Modified Child-Pugh classification. The third group included 30 normal subjects who served as the control group. We determined the level of AFP and endoglin for all cases together with full clinical assessment, liver biochemical profile, conventional US, triphasic abdominal CT scan and guided liver biopsy for HCC cases with atypical CT vascular pattern. Serum AFP was significantly elevated in HCC group [median:303 (25-16000) ng /ml] when compared with both control[median:3.5 (2-5)ng /ml]and cirrhotic [median:5 (4-9.2)ng /ml]groups. Endoglin level was also significantly elevated in the HCC group[median:4.2(0.8-604) ng /ml] when compared with both the control[median:0.3(0.2-0.4)ng /ml] and cirrhotic [median:0.2(0.2-0.3)ng /ml] groups. There is a statistically very highly significantcorrelation between serum endoglin and serum AFP (P <0.001). It was also found that when using a cutoff level of AFP at 12 ng/ml (best cutoff level for the study) it had a sensitivity of 83.33% and a specificity of 86.67%.When considering a cutoff level at 200 ng/ml the sensitivity dropped to 56.7 % but specificity increased to 100%.The cutoff level of endoglin for diagnosis of HCC in this study was 4 ng/ml, with a sensitivity of 53.3 % and specificity of 96.7 %. By the use of the combination of CD105 and AFPSensitivity value ofCD105 could not be further improved,but the specificity increased from 96.7% to 100%,PPV from 94.3 to 100% and NPV from 67.4% to 68.2%. Our study also showed that there is a statistically significant positive correlation between serum endoglin and serum AFP.