Abstract
Objective
To investigate whether there are ultrasound characteristics that can suggest HCC in ultrasound surveillance of nodules in cirrhotic liver.
Methods
Data from 277 patients with hepatitis B virus-related nodules in cirrhotic liver undergoing ultrasound surveillance of the nodules for malignancy were reviewed. Size of the nodules ranged 6–23 mm. The nodules were followed by color Doppler ultrasound at 3- to 6-month intervals, with focus on size, shape, echogenicity, margin, halo sign, and vasculature. Suspicious malignant nodules underwent contrast-enhanced CT/MRI, and some indeterminate nodules underwent biopsy.
Results
Nodules in 189 patients were hypo/isoechoic/faint high echoic, 23 were hyperechoic, and 65 were both hypo/isoechoic/faint high echoic and hyperechoic. Forty-two patients developed hepatocellular carcinoma: 35 from nodules and 7 from background parenchyma. Fourteen nodules recessed (size >10 mm), 11 new nodules emerged (size >10 mm), and the total number of nodules increased over 5 years. All hepatocellular carcinomas developed from hypo/isoechoic/faint high echoic nodules, and no typical hyperechoic nodules developed into hepatocellular carcinomas. The size increased significantly when the nodules developed into hepatocellular carcinomas. No nodule presented an overt halo, seven hepatocellular carcinomas developed from nodules with a halo, and ill-defined margins of 16 nodules became well defined when they developed into hepatocellular carcinomas. No vasculature was detectable in the nodules, while it was detectable in eight hepatocellular carcinomas. No significant change occurred in nodules without malignancy.
Conclusion
The characteristics for dynamic surveillance of nodules in cirrhotic liver for malignancy should include nodule growth, margin, halo, and vasculature. Apart from evident growth, an ill-defined margin becoming a well-defined margin, a newly emerged halo, and newly detectable vasculature are strongly suggestive of nodule malignancy.
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The authors declare there are no financial or other relations that could lead to a conflict of interest.
Human rights statements and informed consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was waived by all patients for being included in the retrospective study.
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Wu, S., Tu, R., Liu, G. et al. Dynamic changes in ultrasound characteristics of nodules in cirrhotic liver and their implications in surveillance for malignancy. J Med Ultrasonics 41, 165–171 (2014). https://doi.org/10.1007/s10396-013-0494-8
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DOI: https://doi.org/10.1007/s10396-013-0494-8