Kim Yeun-Yoon, An Chansik, Kim Do Young, Aljoqiman Khalid Suliman, Choi Jin-Young, Kim Myeong-Jin
Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
Ultrasonography. 2019 Oct;38(4):311-320. doi: 10.14366/usg.18051. Epub 2019 Jan 17.
The purpose of this study was to examine the associations between ultrasonography (US) quality and clinical outcomes in patients undergoing surveillance for hepatocellular carcinoma.
Between 2008 and 2013, 155 patients were diagnosed with liver cancer during regular surveillance by positive US results (US group, n=82) or by computed tomography (CT) or magnetic resonance image (MRI) scanning as alternative modalities (CT/MRI group, n=73). The quality of the echogenic window, macronodularity of the liver parenchyma, and occurrence of surveillance failure (initial tumor diagnosis beyond the Milan criteria or at Barcelona Clinic Liver Cancer stage B or C) were evaluated. Overall survival was compared according to whether surveillance failure occurred.
The patients in the CT/MRI group with negative US results had a higher proportion of parenchymal macronodularity on US than those in the US group (79.5% vs. 63.4%, P=0.028). Surveillance failure tended to be more common in the US group than in the CT/MRI group (40.2% vs. 26.0% by the BCLC staging system [P=0.061]). In the US group, surveillance failure occurred more frequently when the echogenic window was inadequate (50.0% vs. 19.4% by the Milan criteria [P=0.046]). Significantly poorer 5-year overall survival was associated with surveillance failure (P≤0.001).
Parenchymal macronodularity hindered the detection of early-stage tumors during US surveillance. Using an alternative imaging modality may help prevent surveillance failure in patients with macronodular parenchyma on US. Supplemental surveillance strategies than US may also be necessary when the echogenic window is inadequate.
本研究旨在探讨接受肝细胞癌监测的患者中超声检查（US）质量与临床结局之间的关联。
2008年至2013年间，155例患者在定期监测期间被诊断为肝癌，其中82例通过超声检查结果阳性确诊（超声检查组），73例通过计算机断层扫描（CT）或磁共振成像（MRI）扫描作为替代检查方法确诊（CT/MRI组）。评估了回声窗质量、肝实质大结节情况以及监测失败的发生情况（初始肿瘤诊断超出米兰标准或处于巴塞罗那临床肝癌分期B或C期）。根据是否发生监测失败比较总生存期。
超声检查结果为阴性的CT/MRI组患者，其超声检查显示的实质大结节比例高于超声检查组（79.5%对63.4%，P=0.028）。监测失败在美国组中往往比CT/MRI组更常见（根据巴塞罗那临床肝癌分期系统分别为40.2%对26.0%[P=0.061]）。在美国组中，当回声窗不充分时，监测失败更频繁发生（根据米兰标准分别为50.0%对19.4%[P=0.046]）。监测失败与5年总生存期显著较差相关（P≤0.001）。
实质大结节阻碍了超声监测期间早期肿瘤的检测。使用替代成像方法可能有助于预防超声检查显示实质大结节患者的监测失败。当回声窗不充分时，可能也需要超声检查以外的补充监测策略。
