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Potential diagnostic performance of contrast-enhanced ultrasound and tumor markers in differentiating combined hepatocellular–cholangiocarcinoma from hepatocellular carcinoma and cholangiocarcinoma

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Abstract

Purpose

To evaluate the diagnostic performance of the combination of tumor markers [alpha-fetoprotein (AFP) and carbohydrate antigen 19-9 (CA19-9)] and imaging features in differentiating combined hepatocellular–cholangiocarcinoma (CHC) from hepatocellular carcinoma (HCC) and cholangiocarcinoma (CC).

Methods

Forty consecutive patients with pathologically proven CHC were retrospectively evaluated with contrast-enhanced ultrasound (CEUS). Additionally, 40 HCC and 40 CC patients who were randomly selected from the same period served as a control group. Images were classified as HCC-like or CC-like pattern according to CEUS guidelines recommended by World and European Federation for Ultrasound in Medicine and Biology (WFUMB-EFSUMB). The diagnostic criteria of CHC were defined as follows: (1) both AFP and CA19-9 are simultaneously elevated (AFP > 20 ng/ml and CA19-9 > 100 units/ml); or (2) elevated AFP with a CC-like pattern on CEUS and without elevated CA19-9 level; or (3) elevated CA19-9 with an HCC-like pattern on CEUS and without elevated AFP level. The diagnostic tests were performed with calculation of the sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve (AUC).

Results

For the 40 CHC patients, the rates of elevated AFP and CA19-9 serology were 55.0 and 30.0%, respectively. Twenty-three (57.5%) patients exhibited an HCC-like pattern, and 15 (37.5%) showed a CC-like pattern. After applying the above diagnostic criteria of CHC in the 120 patients, the sensitivity, specificity, PPV, NPV, accuracy, and AUC were 32.5, 93.8, 72.2, 73.5, 73.3, and 0.631%, respectively. When the actual prevalence rate (0.4–14.3%) was taken into account, the PPV and NPV were modified from 2.1 to 46.7% and 89.3 to 99.7%, respectively.

Conclusion

The combination of enhancement patterns on CEUS and serum tumor markers (AFP and CA19-9) may be a potentially specific diagnostic method to differentiate CHC from HCC and CC.

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Author information

Author notes

  1. Xiao-wen Huang and Yang Huang contributed equally to this work.

Authors and Affiliations

  1. Department of Medical Ultrasonics, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People’s Republic of China

    Xiao-wen Huang, Yang Huang, Li-da Chen, Zhu Wang, Jin-ya Liu, Xiao-Yan Xie, Ming-De Lu & Wei Wang

  2. Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, People’s Republic of China

    Zheng Yang

  3. Department of Hepatobiliary Surgery, The First Affiliated Hospital of Sun Yat-Sen University, No. 58 Zhongshan Road 2, Guangzhou, 510080, People’s Republic of China

    Shun-li Shen

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  1. Xiao-wen Huang
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Correspondence to Shun-li Shen or Wei Wang.

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Ethical statement

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. The requirement for written informed consent was waived by the committee.

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The authors declare that there are no conflicts of interest for any of the authors.

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Huang, Xw., Huang, Y., Chen, Ld. et al. Potential diagnostic performance of contrast-enhanced ultrasound and tumor markers in differentiating combined hepatocellular–cholangiocarcinoma from hepatocellular carcinoma and cholangiocarcinoma. J Med Ultrasonics 45, 231–241 (2018). https://doi.org/10.1007/s10396-017-0834-1

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  • DOI: https://doi.org/10.1007/s10396-017-0834-1

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