Department of Medical Ultrasound, First Affiliated Hospital of Guangxi Medical University, No. 6 Shuangyong Rd, Nanning 530021, Guangxi, China.
Department of Ultrasound, Affiliated Tumor Hospital of Guangxi Medical University, Nanning 530021, Guangxi, China.
J Cancer Res Ther. 2024 Aug 1;20(4):1274-1283. doi: 10.4103/jcrt.jcrt_125_24. Epub 2024 Aug 29.
We found that the occurrence of hepatocellular carcinoma (HCC) has increased significantly in non-cirrhotic individuals, with HCC being frequently overlooked or misdiagnosed. Contrast-enhanced ultrasound (CEUS) Liver Imaging Reporting and Data System (LI-RADS) is known to have a high diagnostic quality in high-risk HCC patients. Therefore, we aimed to compare the detection accuracy of CEUS LI-RADS for HCC between low- and high-risk individuals, to confirm its value in low-risk patients at increased risk of HCC, but not yet included in the high-risk groups of LI-RADS. In addition, since CEUS LR-4 and LR-M categories contain a relatively high proportion of HCC, and serum alpha-fetoprotein (AFP) is the most commonly used biomarker for HCC, and the clinically valid, we attempted to further improve the early diagnostic capability of CEUS LI-RADS for HCC in the low-risk and high-risk patients by combining CEUS LR-4 and LR-M categories with AFP.
We defined high-risk groups (HR)-included in the high-risk patients of LI-RADS, low-risk groups (LR)-not included in the high-risk patients of LI-RADS and enrolled 189 HCC patients with LR and HR settings in a retrospective study. All lesions were confirmed histopathologically. The CEUS LI-RADS accuracy for detecting HCC in these two patients was compared. In addition, the diagnostic algorithm in our study was proposed (for CEUS LR-4 and LR-M patients with AFP>20 ng/ml). we analyzed the ability of CEUS LI-RADS as a valid method of establishing the early diagnosis of HCC in LR and HR patients by combining LR-4 and LR-M categories with AFP.
Through comparative analysis, the specificity of the CEUS LR-5 category for HCC in the HR group was 78.4%, whereas in the LR group, it was 94.2%. Meanwhile, the sensitivity (63.2% vs. 63.0%) and positive predictive value (PPV) (75.0% vs. 88.7%) did not differ between the LR and HR groups ( P = 0.990, P = 0.299). It is noteworthy that there were the high proportion of HCC in CEUS LR-4 and LR-M categories in our cases and when we combined CEUS LR-4 and LR-M categories with AFP significantly improved the sensitivity by 21.0% (84.2%) in the LR group, and by 16.0% (79.0%) in the HR group, with statistically difference in sensitivity after combination in the HR group ( P = 0.014).
The CEUS LR-5 category has real meaningful utility in the diagnosis of HCC in both LR and HR patients. The early detection power of the CEUS LI-RADS category for HCC patients was further increased when the CEUS LR-4 and LR-M categories were combined with elevated AFP.
我们发现非肝硬化个体中肝细胞癌（HCC）的发生率显著增加，且 HCC 经常被忽视或误诊。增强超声（CEUS）肝脏成像报告和数据系统（LI-RADS）在高危 HCC 患者中具有较高的诊断质量。因此，我们旨在比较低危和高危个体中 CEUS LI-RADS 对 HCC 的检测准确性，以确认其在高危但尚未纳入 LI-RADS 高危组的低危 HCC 患者中的价值。此外，由于 CEUS LR-4 和 LR-M 类别中包含相对较高比例的 HCC，且血清甲胎蛋白（AFP）是 HCC 最常用的生物标志物，且在临床上有效，因此我们试图通过将 CEUS LR-4 和 LR-M 类别与 AFP 相结合，进一步提高低危和高危患者中 CEUS LI-RADS 对 HCC 的早期诊断能力。
我们定义了高危组（HR）-包括在 LI-RADS 的高危患者中，低危组（LR）-不包括在 LI-RADS 的高危患者中，并在回顾性研究中纳入了 189 名 LR 和 HR 设置的 HCC 患者。所有病变均经组织病理学证实。比较这两组患者中 CEUS LI-RADS 对 HCC 的检测准确性。此外，我们提出了研究中的诊断算法（对于 AFP>20ng/ml 的 CEUS LR-4 和 LR-M 患者）。我们分析了通过将 LR-4 和 LR-M 类别与 AFP 相结合，CEUS LI-RADS 作为建立 LR 和 HR 患者早期 HCC 诊断的有效方法的能力。
通过对比分析，HR 组中 CEUS LR-5 类别对 HCC 的特异性为 78.4%，而 LR 组为 94.2%。同时，LR 和 HR 组之间的敏感性（63.2% vs. 63.0%）和阳性预测值（PPV）（75.0% vs. 88.7%）无差异（P=0.990，P=0.299）。值得注意的是，我们的病例中 CEUS LR-4 和 LR-M 类别中 HCC 的比例较高，当我们将 CEUS LR-4 和 LR-M 类别与 AFP 结合使用时，LR 组的敏感性提高了 21.0%（84.2%），HR 组提高了 16.0%（79.0%），HR 组的敏感性在结合后有统计学差异（P=0.014）。
CEUS LR-5 类别在 LR 和 HR 患者的 HCC 诊断中具有实际意义。当将 CEUS LR-4 和 LR-M 类别与升高的 AFP 结合使用时，CEUS LI-RADS 类别对 HCC 患者的早期检测能力进一步提高。
