Department of Ultrasound, Eastern Hepatobiliary Surgery Hospital, The Third Affiliated Hospital of Naval Medical University, Shanghai 200433, China.
Department of Pathology, Shanghai Eastern Hepatobiliary Surgery Hospital, Third Affiliated Hospital of Naval Medical University, Shanghai 200433, China.
World J Gastroenterol. 2024 Jul 7;30(25):3166-3178. doi: 10.3748/wjg.v30.i25.3166.
Integrating conventional ultrasound features with 2D shear wave elastography (2D-SWE) can potentially enhance preoperative hepatocellular carcinoma (HCC) predictions.
To develop a 2D-SWE-based predictive model for preoperative identification of HCC.
A retrospective analysis of 884 patients who underwent liver resection and pathology evaluation from February 2021 to August 2023 was conducted at the Oriental Hepatobiliary Surgery Hospital. The patients were divided into the modeling group ( = 720) and the control group ( = 164). The study included conventional ultrasound, 2D-SWE, and preoperative laboratory tests. Multiple logistic regression was used to identify independent predictive factors for malignant liver lesions, which were then depicted as nomograms.
In the modeling group analysis, maximal elasticity (Emax) of tumors and their peripheries, platelet count, cirrhosis, and blood flow were independent risk indicators for malignancies. These factors yielded an area under the curve of 0.77 (95% confidence interval: 0.73-0.81) with 84% sensitivity and 61% specificity. The model demonstrated good calibration in both the construction and validation cohorts, as shown by the calibration graph and Hosmer-Lemeshow test ( = 0.683 and = 0.658, respectively). Additionally, the mean elasticity (Emean) of the tumor periphery was identified as a risk factor for microvascular invasion (MVI) in malignant liver tumors ( = 0.003). Patients receiving antiviral treatment differed significantly in platelet count ( = 0.002), Emax of tumors ( = 0.033), Emean of tumors ( = 0.042), Emax at tumor periphery ( < 0.001), and Emean at tumor periphery ( = 0.003).
2D-SWE's hardness value serves as a valuable marker for enhancing the preoperative diagnosis of malignant liver lesions, correlating significantly with MVI and antiviral treatment efficacy.
整合常规超声特征与二维剪切波弹性成像（2D-SWE）可提高术前肝细胞癌（HCC）的预测能力。
建立基于 2D-SWE 的预测模型，用于术前识别 HCC。
回顾性分析 2021 年 2 月至 2023 年 8 月在东方肝胆外科医院行肝切除术和病理评估的 884 例患者。患者分为建模组（n=720）和对照组（n=164）。研究包括常规超声、2D-SWE 和术前实验室检查。多因素逻辑回归用于识别恶性肝病变的独立预测因素，然后将其描绘为列线图。
在建模组分析中，肿瘤及其周围的最大弹性（Emax）、血小板计数、肝硬化和血流是恶性肿瘤的独立危险因素。这些因素的曲线下面积为 0.77（95%置信区间：0.73-0.81），敏感性为 84%，特异性为 61%。校准图和 Hosmer-Lemeshow 检验显示模型在构建和验证队列中均具有良好的校准（=0.683 和=0.658）。此外，肿瘤外周的平均弹性（Emean）被确定为恶性肝肿瘤微血管侵犯（MVI）的危险因素（=0.003）。接受抗病毒治疗的患者血小板计数（=0.002）、肿瘤 Emax（=0.033）、肿瘤 Emean（=0.042）、肿瘤外周 Emax（<0.001）和肿瘤外周 Emean（=0.003）差异有统计学意义。
2D-SWE 的硬度值是增强恶性肝病变术前诊断的有价值标志物，与 MVI 和抗病毒治疗效果显著相关。
