Abstract
Purpose: To explore the diagnostic value of Contrast-enhanced Ultrasound Liver Imaging Reporting and Data System version 2017 (CEUS LI-RADS v2017) in differentiating alpha-fetoprotein (AFP)-negative hepatocellular carcinoma (HCC) from other primary malignancies (OM) of the liver. Methods: The data of 99 patients with primary liver malignant tumors confirmed by surgical pathology and AFP-negative from January 2018 to January 2021 were retrospectively analyzed, and the lesions were divided into 61 cases in the AFP-negative HCC group and 38 cases in the OM group according to the pathological findings, the CEUS features of the lesions were analyzed and the lesions were classified according to the CEUS LI-RADS v2017. Comparison of CEUS features between the two groups was performed using the χ2 test. The sensitivity, specificity, positive predictive value, negative predictive value, and coincidence rate of CEUS LI-RADS v2017 for the diagnosis of AFP-negative HCC and OM were calculated using pathological findings as the gold standard. Results: The differences in features of arterial phase enhancement and wash-out between the HCC and OM groups were statistically significant (p < 0.05). The sensitivity of diagnosing HCC by LR-5 was 62.3% and the specificity was 92.1%. The sensitivity of diagnosing OM by LR-M was 92.1% and the specificity was 83.6%. Conclusions: When AFP is negative in patients with intrahepatic focal lesions, LR-5 has high specificity but low sensitivity in the diagnosis of HCC, and LR-M has high sensitivity and specificity in the diagnosis of OM. CEUS LI-RADS is a tool to differentiate AFP-negative HCC and OM effectively.
Highlights
Primary malignancies of the liver include primary hepatocellular carcinoma (HCC), intrahepatic-cholangiocarcinoma (ICC), combined hepatocellular–cholangiocarcinoma (CHC) and other rare types of tumors
Alpha-fetoprotein (AFP) is an important serological marker for early screening of HCC, but since about 30–40% of HCC patients are clinically negative for AFP [7], it is easy to misdiagnose AFP-negative patients as other liver tumors, so early and accurate preoperative diagnosis and differentiation of AFP-negative HCC from other primary hepatic malignancy (OM) are important for the selection of clinical treatment options and improvement of prognosis [8]
The 99 AFP—negative intrahepatic primary malignant tumors were divided into HCC group (61 cases) and OM group (38 cases, including 31 cases of intrahepatic cholangiocarcinoma, 2 cases of combined hepatocellular carcinoma and cholangiocarcinoma, 3 cases of lymphoma, 1 case of angiosarcoma and 1 case of spindle cell sarcoma) according to pathological findings
Summary
Primary malignancies of the liver include primary hepatocellular carcinoma (HCC), intrahepatic-cholangiocarcinoma (ICC), combined hepatocellular–cholangiocarcinoma (CHC) and other rare types of tumors. Alpha-fetoprotein (AFP) is an important serological marker for early screening of HCC, but since about 30–40% of HCC patients are clinically negative for AFP [7], it is easy to misdiagnose AFP-negative patients as other liver tumors, so early and accurate preoperative diagnosis and differentiation of AFP-negative HCC from OM are important for the selection of clinical treatment options and improvement of prognosis [8]. Previous studies have found that the CEUS LI-RADS classification can predict the risk of developing HCC in high-risk patients with hepatocellular carcinoma. The purpose of this study is to explore the differential diagnostic value of CEUS LI-RADS v2017 for AFP-negative HCC and OM, with the aim of making an early and accurate diagnosis of AFP-negative intrahepatic lesions and providing a more valuable imaging basis for the selection of clinical treatment options
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