Yan Shijun
Ultrasound Department, Ziyang Yanjiang District People's Hospital, Ziyang, Sichuan, China.
Medicine (Baltimore). 2025 Jul 11;104(28):e43205. doi: 10.1097/MD.0000000000043205.
This study assesses the diagnostic performance of ultrasonography combined with serum biomarkers (alpha-fetoprotein [AFP], serum amyloid A [SAA], and C-reactive protein [CRP]) for early detection of hepatocellular carcinoma (HCC) in high-risk individuals, and to evaluate diagnostic agreement using the kappa coefficient to inform optimized screening strategies. A retrospective cohort of 100 high-risk patients screened for HCC between January 2022 and December 2023 was analyzed. Patients were assigned to an experimental group (n = 50; ultrasound + AFP, SAA, CRP) or a control group (n = 50; AFP, SAA, CRP only). Diagnostic performance was evaluated by detection rate, sensitivity, specificity, positive predictive value, negative predictive value, and agreement with contrast-enhanced CT and pathology, using the kappa coefficient (κ). The experimental group exhibited significantly higher detection rate (76.0% vs 50.0%, P = .01), sensitivity (88.4% vs 64.1%, P = .01), specificity (92.0% vs 78.0%, P = .04), positive predictive value (95.0% vs 78.1%, P = .02), and negative predictive value (82.1% vs 64.0%, P = .03). The kappa coefficient indicated good diagnostic agreement in the experimental group (κ = 0.81) and moderate agreement in the control group (κ = 0.56). Ultrasonography combined with AFP, SAA, and CRP significantly improves early HCC detection and diagnostic consistency and may serve as a routine screening tool in high-risk populations. Integration with artificial intelligence and elastography may further enhance screening accuracy.
本研究评估超声检查联合血清生物标志物（甲胎蛋白[AFP]、血清淀粉样蛋白A[SAA]和C反应蛋白[CRP]）对高危个体早期肝细胞癌（HCC）的诊断性能，并使用kappa系数评估诊断一致性，以指导优化筛查策略。对2022年1月至2023年12月期间筛查HCC的100例高危患者的回顾性队列进行了分析。患者被分为实验组（n = 50；超声+AFP、SAA、CRP）或对照组（n = 50；仅AFP、SAA、CRP）。通过检测率、敏感性、特异性、阳性预测值、阴性预测值以及与增强CT和病理学的一致性，使用kappa系数（κ）评估诊断性能。实验组的检测率（76.0%对50.0%，P = 0.01）、敏感性（88.4%对64.1%，P = 0.01）、特异性（92.0%对78.0%，P = 0.04）、阳性预测值（95.0%对78.1%，P = 0.02）和阴性预测值（82.1%对64.0%，P = 0.03）显著更高。kappa系数表明实验组诊断一致性良好（κ = 0.81），对照组一致性中等（κ = 0.56）。超声检查联合AFP、SAA和CRP可显著提高早期HCC检测率和诊断一致性，并可作为高危人群的常规筛查工具。与人工智能和弹性成像相结合可能会进一步提高筛查准确性。
