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Preoperative prediction of macrotrabecular-massive hepatocellular carcinoma based on B-Mode US and CEUS

  • Ultrasound
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Objectives

To develop a preoperative prediction model to identify macrotrabecular-massive hepatocellular carcinoma (MTM-HCC) and evaluate the model’s diagnostic performance in differentiating MTM-HCC from HCC.

Methods

We conducted a mono-center retrospective study in a grade A tertiary hospital in China. Consecutive patients with suspected HCC from February 2019 to December 2020 were eligible for inclusion. All consenting patients underwent CEUS examination and were histologically diagnosed. Based on the clinical and US features between the two groups, we developed a binary logistic regression model and a nomogram for predicting MTM-HCC.

Results

A total of 161 patients (median age, 57 years; interquartile range, 48–64 years; 129 men) were included in the analysis. Twenty-seven of the HCCs (16.8%) were of the MTM subtype. Binary logistic regression analysis indicated that PVP hypoenhancement (OR = 15.497; 95% CI: 1.369, 175.451; p = 0.027), AFP > 454.6 ng/mL (OR = 8.658; 95% CI: 3.030, 24.741; p < 0.001), ALB ≤ 29.9 g/L (OR = 3.937; 95% CI: 1.017, 15.234; p = 0.047), halo sign (OR = 3.868; 95% CI: 1.314, 11.391; p = 0.016), and intratumoral artery (OR = 2.928; 95% CI: 1.039, 8.255; p = 0.042) were predictors for MTM subtype. Combining any two criteria showed a high sensitivity (100.0%); combining all five criteria showed a high specificity (99.2%); and the AUC value of the logistic regression model was 0.88 (95% CI: 0.81, 0.92).

Conclusions

BMUS and CEUS could be used for identifying patients suspected of having MTM-HCC. Combining clinical information, BMUS, and CEUS features could achieve a noninvasive diagnosis of MTM-HCC.

Key Points

• Contrast-enhanced ultrasound examination helps clinicians to identify MTM-HCCs preoperatively.

• PVP hypoenhancement, high AFP levels, low ALB levels, halo signs, and intratumoral arteries could be used to predict MTM-HCCs.

• A logistic regression model and nomogram were built to noninvasively diagnose MTM-HCCs with an AUC value of 0.88 (95% CI: 0.81, 0.92).

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Abbreviations

AFP:

Alpha-fetoprotein

ALB:

Albumin

BCLC:

Barcelona Clinic Liver Cancer

BMUS:

B-mode ultrasound

E–S:

Edmondson-Steiner

MTM-HCC:

Macrotrabecular-massive hepatocellular carcinoma

TNM:

Tumor node metastasis

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Acknowledgements

We thank He Guan, Ph.D., for assistance in statistical analysis.

Funding

This study has received funding from the National Nature Science Foundation of China (Grant Number 82171944,81873899) and Nature Science Foundation of Guangdong Province (Grant Number 2021A1515012611).

Author information

Author notes

  1. Man Luo, Xiaodi Liu, and Juanjuan Yong contributed equally to this work and both should be considered as co-first authors.

Authors and Affiliations

  1. Department of Ultrasound, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No.33 Yingfeng Road, Guangzhou, 510289, China

    Man Luo, Xiaodi Liu, Bing Ou, Xiaolin Xu, Xinbao Zhao, Ming Liang, Zizhuo Zhao, Jingliang Ruan & Baoming Luo

  2. Laboratory of Ultrasound Medicine, West China Hospital, Sichuan University, No.37 Guoxue Alley, Chengdu, 610065, China

    Xiaodi Liu

  3. Department of Pathology, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, No.33 Yingfeng Road, Guangzhou, 510289, China

    Juanjuan Yong

  4. Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, No.33 Yingfeng Road, Guangzhou, 510289, China

    Jingliang Ruan & Baoming Luo

Authors
  1. Man Luo
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  2. Xiaodi Liu
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Corresponding authors

Correspondence to Jingliang Ruan or Baoming Luo.

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The scientific guarantor of this publication is Prof. Baoming Luo.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• diagnostic study

• performed at one institution

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Jingliang Ruan and Baoming Luo are considered co-corresponding authors.

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Luo, M., Liu, X., Yong, J. et al. Preoperative prediction of macrotrabecular-massive hepatocellular carcinoma based on B-Mode US and CEUS. Eur Radiol 33, 4024–4033 (2023). https://doi.org/10.1007/s00330-022-09322-0

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