A non-smooth tumor margin on preoperative imaging assesses microvascular invasion of hepatocellular carcinoma: A systematic review and meta-analysis

Hangtong Hu,Jingya Liu,Xiaoyan Xie,Shi Ting Feng,Zhi Cheng Lai,Xiao Wen Huang,Qiao Zheng,Yang Huang,Ming De Lu,Wei Wang

doi:10.1038/s41598-017-15491-6

Abstract

Microvascular invasion (MVI) is rarely diagnosed preoperatively in hepatocellular carcinoma (HCC). The aim of this meta-analysis is to assess the diagnostic power of a non-smooth tumor margin on preoperative imaging for MVI. We performed a literature search using the PubMed, Embase and Cochrane Library databases, and 11 studies were included involving 618 MVI-positive cases and 1030 MVI-negative cases. Considerable heterogeneity was found, and was indicated to be attributable to the mean patient ages in the included studies. In subgroups of studies with a mean patient age older than 60 years and studies with computed tomography (CT) as the imaging method (as opposed to magnetic resonance imaging (MRI)), heterogeneity was low, and the diagnostic odds ratio (DOR) of the single two-dimensional imaging feature for MVI was 21.30 (95% CI [12.52, 36.23]) and 28.78 (95% CI [13.92, 59.36]), respectively; this power was equivalent to or greater than that of certain multivariable-based scoring systems. In conclusion, a non-smooth tumor margin on preoperative imaging is of great value for MVI assessment and should be considered for inclusion in future scoring systems.

Highlights

A non-smooth tumor margin on preoperative imaging assesses microvascular invasion of hepatocellular carcinoma: A systematic review and metaanalysis
The remaining 65 studies were subjected to full-text review, and 59 of these studies were excluded for overlapping population (3 studies), sample size smaller than 30 (1 study), involving gross analyses of non-smooth tumor margins (7 studies), or containing no valid extractable data for our meta-analysis
Preoperative Microvascular invasion (MVI) assessment has become clinically possible given the discovery of associations between a pathological diagnosis of MVI and imaging/clinical features, proteomics characteristics and gene signatures 2,25–27

Summary

Introduction

A non-smooth tumor margin on preoperative imaging assesses microvascular invasion of hepatocellular carcinoma: A systematic review and metaanalysis. The aim of this meta-analysis is to assess the diagnostic power of a non-smooth tumor margin on preoperative imaging for MVI. In subgroups of studies with a mean patient age older than 60 years and studies with computed tomography (CT) as the imaging method (as opposed to magnetic resonance imaging (MRI)), heterogeneity was low, and the diagnostic odds ratio (DOR) of the single two-dimensional imaging feature for MVI was 21.30 (95% CI [12.52, 36.23]) and 28.78 (95% CI [13.92, 59.36]), respectively; this power was equivalent to or greater than that of certain multivariable-based scoring systems. A non-smooth tumor margin on preoperative imaging is of great value for MVI assessment and should be considered for inclusion in future scoring systems. If MVI is detected, an adjuvant therapy such as sorafenib treatment[8] or trans-arterial chemoembolization (TACE)[9] could be used, given that these approaches have been reported to improve survival for HCC patients with MVI

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Results

Conclusion