Jiang Yandong, Zhang Meng, Zhu Yanting, Zhu Dongxiao
Department of Ultrasound, Affiliated Hospital of Jiangnan University, Wuxi, China.
J Gastrointest Oncol. 2021 Oct;12(5):2403-2411. doi: 10.21037/jgo-21-611.
Early diagnosis of hepatocellular carcinoma (HCC) is very important for the prognosis of patients. However, there are very few studies that compared the diagnostic accuracy of contrast-enhanced ultrasonography (CEUS) and B-mode ultrasonography for early HCC in cirrhotic patients.
This retrospective study included cirrhotic patients, who were suspected of early HCC between January 2020 and June 2021. The diagnosis of patients was based on the pathology results of surgery or biopsy. Demographic and clinical characteristics of included patients were recorded. The diagnoses of suspected lesions using both types of ultrasonography were recorded, and the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy of early HCC in cirrhotic patients were calculated.
Eventually, 137 patients with solitary lesions in the liver were included in this study, including 89 patients diagnosed with HCC and 48 patients diagnosed with non-HCC. The median diameter of suspected lesions was 26 mm, and the median level of alpha fetoprotein (AFP) was 37.2 ng/mL. When comparing the demographic and clinical characteristics of cirrhotic patients with HCC and non-HCC, it was found that patients with HCC had significantly higher levels of AFP than those with non-HCC (P=0.03). The sensitivity, specificity, PPV, NPV, and accuracy of CEUS in early HCC were 73%, 93.8%, 95.6%, 65.2% and 80.3%, respectively. In CEUS, all of these parameters were much higher than those in B-mode ultrasonography, i.e., 64%, 75%, 82.6%, 52.9%, and 67.9%. It was also found that the diagnostic accuracy of CEUS was much higher than that of B-mode ultrasonography especially regarding lesions <20 mm. To further improve the sensitivity of CEUS in early HCC, AFP was combined with CEUS for the diagnosis of early HCC. As a result, the sensitivity, specificity, PPV, NPV, and accuracy of CEUS combined with AFP level were 83.1%, 87.5%, 92.5%, 73.7%, and 84.7%, respectively.
Our study confirmed that CEUS' diagnostic accuracy for early HCC in cirrhotic patients was significantly higher than that of B-mode ultrasonography. However, the sensitivity of CEUS needs to be improved further, and the combination of CEUS and AFP level may be a potential solution.
肝细胞癌（HCC）的早期诊断对患者的预后非常重要。然而，很少有研究比较超声造影（CEUS）和B超对肝硬化患者早期HCC的诊断准确性。
这项回顾性研究纳入了2020年1月至2021年6月期间疑似早期HCC的肝硬化患者。患者的诊断基于手术或活检的病理结果。记录纳入患者的人口统计学和临床特征。记录使用两种超声检查对疑似病变的诊断情况，并计算肝硬化患者早期HCC的敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确性。
最终，本研究纳入了137例肝脏有孤立性病变的患者，其中89例被诊断为HCC，48例被诊断为非HCC。疑似病变的中位直径为26mm，甲胎蛋白（AFP）的中位水平为37.2ng/mL。比较HCC和非HCC肝硬化患者的人口统计学和临床特征时发现，HCC患者的AFP水平显著高于非HCC患者（P=0.03）。CEUS对早期HCC的敏感性、特异性、PPV、NPV和准确性分别为73%、93.8%、95.6%、65.2%和80.3%。在CEUS中，所有这些参数均远高于B超，即64%、75%、82.6%、52.9%和67.9%。还发现CEUS的诊断准确性远高于B超，尤其是对于直径<20mm的病变。为进一步提高CEUS对早期HCC的敏感性，将AFP与CEUS联合用于早期HCC的诊断。结果，CEUS联合AFP水平的敏感性、特异性、PPV、NPV和准确性分别为83.1%、87.5%、92.5%、73.7%和84.7%。
我们的研究证实，CEUS对肝硬化患者早期HCC的诊断准确性显著高于B超。然而，CEUS的敏感性需要进一步提高，CEUS与AFP水平联合可能是一个潜在的解决方案。
