Contrastingly, an analysis of 236 cases in Washington state yielded only 3 cases positive for SALL4 (1.3%); however, the validity of the results remains questionable due to multiple shortcomings of the study which include a deviation from published liver carcinoma staining protocols and the use of a core biopsy method known to be highly susceptible to sampling bias and false negatives (44). This evidence concerns the gene SALL4 and hepatocellular carcinoma.