title: Prospective evaluation of the diagnostic accuracy of hepatic copper content, as determined using the entire core of a liver biopsy sample.
abstract: Hepatic copper determination is an important test for the diagnosis of Wilson's disease (WD). However, the method has not been standardized, the diagnostic accuracy has not been evaluated prospectively, and the optimal cut-off value remains controversial. Accordingly, we aimed to prospectively evaluate the diagnostic accuracy of hepatic copper content, as determined using the entire core of a liver biopsy sample. Patients for whom a liver biopsy was indicated were consecutively enrolled. Hepatic copper content was determined with atomic absorption spectroscopy. All assays were performed using careful quality control by a single technician. WD diagnosis was based on WD score or its combination with clinical follow-up results. A total of 3,350 consecutive patients underwent liver biopsy. Six hundred ninety-one patients, including 178 with WD, underwent two passes of liver biopsy with hepatic copper determination. Mean hepatic content in WD patients was 770.6 ± 393.2 μg/g dry weight (wt). Sensitivity, specificity, and positive and negative predictive values of hepatic copper content for WD diagnosis in the absence of primary biliary cirrhosis (PBC) or primary sclerosing cholangitis at the cut-off value of 250 μg/g dry wt. were 94.4%, 96.8%, 91.8%, and 97.8%, respectively. The most useful cut-off value was 209 μg/g dry wt, with a sensitivity and specificity of 99.4% and 96.1%, respectively. A total of 23.3% of patients without WD and PBC had hepatic copper content >75 μg/g dry wt.
  
  
  CONCLUSIONS
  A liver biopsy sample of more than 1 mg dry wt may reliably reflect hepatic copper content and should be used for hepatic copper determination. Hepatic copper determination is a very valid procedure for the diagnosis of WD, and the most useful cut-off value is 209 μg/g dry wt.
authors.affiliation: Liver Disease Research Center, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Xu
authors.initials: X
authors.lastname: Yang
authors.affiliation: Liver Disease Research Center, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Xiao-peng
authors.initials: XP
authors.lastname: Tang
authors.affiliation: Liver Disease Research Center, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Yong-hong
authors.initials: YH
authors.lastname: Zhang
authors.affiliation: Liver Disease Research Center, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Kai-zhong
authors.initials: KZ
authors.lastname: Luo
authors.affiliation: Liver Disease Research Center, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Yong-fang
authors.initials: YF
authors.lastname: Jiang
authors.affiliation: Liver Disease Research Center, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Hong-yu
authors.initials: HY
authors.lastname: Luo
authors.affiliation: Liver Disease Research Center, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Jian-hua
authors.initials: JH
authors.lastname: Lei
authors.affiliation: Liver Disease Research Center, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Wen-long
authors.initials: WL
authors.lastname: Wang
authors.affiliation: Liver Disease Research Center, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Ming-ming
authors.initials: MM
authors.lastname: Li
authors.affiliation: Department of Biochemistry, School of Life Sciences, Central South University, Changsha, China.
authors.forename: Han-chun
authors.initials: HC
authors.lastname: Chen
authors.affiliation: Research Laboratory of Spectral and Chemical Analysis Center of Modern Analysis and Testing, Central South University, Changsha, China.
authors.forename: Shi-lin
authors.initials: SL
authors.lastname: Deng
authors.affiliation: Liver Disease Research Center, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Li-ying
authors.initials: LY
authors.lastname: Lai
authors.affiliation: Liver Disease Research Center, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Liang
authors.affiliation: Liver Disease Research Center, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Min
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Liver Disease Research Center, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Tian
authors.affiliation: Liver Disease Research Center, the Second Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Yun
authors.initials: Y
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003300:Copper / Q000032:analysis*; D005260:Female; D006527:Hepatolenticular Degeneration / Q000473:pathology*; D006801:Humans; D007223:Infant; D008099:Liver / Q000737:chemistry* / Q000473:pathology*; D008297:Male; D011446:Prospective Studies; D015203:Reproducibility of Results; D055815:Young Adult
chemical_list: D003300:Copper