To explore the correlation between two-dimensional ultrasound (2D-US), contrast-enhanced ultrasound (CEUS) and microvascular invasion (MVI) in hepatocellular carcinoma (HCC).
METHODS:
In this retrospective study, 56 patients with surgically pathologically confirmed HCC lesions were included. Patients were classified according to the presence of MVI: MVI positive group (n = 17) and MVI negative group (n = 39). 2D-US and CEUS examinations were performed within two weeks before surgery. The 2D-US and CEUS features were analyzed for correlation with MVI. Statistically significant parameters of ultrasound characteristic were scored, and the results of the scores were analyzed by ROC curve.
RESULTS:
There were statistically significant differences in tumor shape, boundary, capsule, CEUS portal phase and delayed phase enhancement pattern, time to wash out, and tumor margin after enhancement (P < 0.05), while there were no statistically significant differences in tumor location and size, CEUS arterial phase enhancement pattern, initial time, time to peak, and peritumor enhancement (P > 0.05). When diagnosing the presence of MVI in HCC patients with cut-off value of the score combined 2D-US and CEUS features≥3, the maximum Jorden index was 0.58, and its diagnostic sensitivity and specificity were 94.10% and 64.1%, respectively, meaning that the total score≥3 was highly suspicious of the presence of MVI.
CONCLUSIONS:
2D-US and CEUS are feasible methods for preoperative prediction of MVI in HCC, and can provide some theoretical basis for individualized clinical treatment.
SiegelRL, MillerKD, JemalA. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7–30.
2.
BrayF, FerlayJ, SoerjomataramI, SiegelRL, TorreLA, JemalA. Global cancer statistics GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6)::394–424.
3.
AsraniSK, DevarbhaviH, EatonJ, KamathPS. Burden of liver diseases in the world. J Hepatol. 2019;70(1):151–71.
4.
McGlynnKA, PetrickJL, LondonWT. Global epidemiology of hepatocellular carcinoma: an emphasis on demographic and regional variability. Clin Liver Dis. 2015;19(2):223–38.
5.
XiaYX, ZhangF, LiXC,
KongLB,
ZhangH,
LiDH,
et al. Surgical treatment of primary liver cancer:a report of 10 966 cases. Zhonghua Wai Ke Za Zhi. 2021;59(1):6–17.
6.
MenyhártO, NagyÁ, GyőrffyB. Determining consistent prognostic biomarkers of overall survival and vascular invasion in hepatocellular carcinoma. R Soc Open Sci. 2018;5(12):181006.
7.
YangP,
SiA,
YangJ,
ChengZ,
WangK,
LiJ, et al. A wide-margin liver resection improves long-term outcomes for patients with HBV-related hepatocellular carcinoma with microvascular invasion. Surgery. 2019;165(4):721–30.
8.
CourtCM,
Harlander-LockeMP,
MarkovicD,
FrenchSW,
NainiBV,
LuDS, et al. Determination of hepatocellular carcinoma grade by needle biopsy is unreliable for liver transplant candidate selection. Liver transplantation. 2017;23(9):1123–32.
9.
RussoF, ImondiA, LynchE,
FarinatiF. When and how should we perform a biopsy for HCC in patients with liver cirrhosis in 2018? A review. Digestive and Liver Disease. 2018;50(7):640–6.
10.
MarschnerCA, ZhangL, SchwarzeV, VölckersW, FroelichMF, von MünchhausenN, et al. The diagnostic value of contrast-enhanced ultrasound (CEUS) for assessing hepatocellular carcinoma compared to histopathology; a retrospective single-center analysis of 119 patients1. Clin Hemorheol Microcirc. 2020;76(4):453–8.
11.
SchwarzeV, MarschnerC, VölckersW, de FigueiredoGN, RübenthalerJ, ClevertDA. The diagnostic performance of contrast-enhanced ultrasound (CEUS) for evaluating hepatocellular carcinoma (HCC) juxtaposed to MRI findings; a retrospective single-center analysis of 292 patients. Clin Hemorheol Microcirc. 2020;76(2):155–60.
12.
WildnerD, SchellhaasB, StrackD, GoertzRS, PfeiferL, FiesslerC, et al. Differentiation of malignant liver tumors by software-based perfusion quantification with dynamic contrast-enhanced ultrasound (DCEUS). Clin Hemorheol Microcirc. 2019;71(1):39–51.
13.
DongY, QiuY, YangD, YuL, ZuoD, ZhangQ, et al. Potential application of dynamic contrast enhanced ultrasound in predicting microvascular invasion of hepatocellular carcinoma. Clin Hemorheol Microcirc. 2021 Jan 12.
14.
ChouCT,
ChenRC,
LinWC,
KoCJ,
ChenCB,
ChenYL. Prediction of microvascular invasion of hepatocellular carcinoma: preoperative CT and histopathologic correlation. AJR Am J Roentgenol. 2014;203(3):W253–9.
15.
SumieS,
KuromatsuR,
OkudaK,
AndoE,
TakataA,
FukushimaN. Microvascular invasion in patients with hepatocellular carcinoma and its predictable clinicopathological factors. Ann Surg Oncol. 2008;15:1375–82.
16.
Liver Cancer Professional Committee of China Anti-Cancer Association, liver Cancer Group of Hepatology Branch of Chinese Medical Association, Pathology Committee of China Anti-Cancer Association, et al. Guidelines for standardized pathological diagnosis of Primary liver Cancer (2015 Edition). Journal of Clinical Hepatobiliary Diseases.
2015;31(6):833–9.
17.
HuangM,
LiaoB,
XuP,
CaiH,
HuangK,
DongZ, et al. Prediction of Microvascular Invasion in Hepatocellular Carcinoma: Preoperative Gd-EOB-DTPA-Dynamic Enhanced MRI and Histopathological Correlation. Contrast Media Mol Imaging. 2018;2018:9674565.
18.
KanaiT,
HirohashiS,
UptonMP,
NoguchiM,
KishiK,
MakuuchiM, et al. Pathology of small hepatocellular carcinoma: a proposal for a new gross classification. Cancer. 1987;60:810–9.
19.
HuH, ZhengQ, HuangY, HuangXW, LaiZC, LiuJ, et al. A non-smooth tumor margin on preoperative imaging assesses microvascular invasion of hepatocellular carcinoma: A systematic review and meta-analysis. Sci Rep. 2017;7(1):15375.
20.
EguchiS,
TakatsukiM,
HidakaM,
SoyamaA,
TomonagaT,
MuraokaI, et al. Predictor for histological microvascular invasion of hepatocellular carcinoma: a lesson from 229 consecutive cases of curative liver resection. World J Surg. 2010;34:1034–8.
21.
NaganoY,
ShimadaH,
TakedaK,
UedaM,
MatsuoK,
TanakaK, et al. Predictive factors of microvascular invasion in patients with hepatocellular carcinoma larger than 5 cm. World J Surg. 2008;32:2218–22.
22.
CaoY,
JiangZ,
WangS,
ZhangH,
JiangY,
LvL. Prediction of long term survival rates in patients undergoing curative resection for solitary hepatocellular carcinoma. Oncol Lett. 2018;15(2):2574–82.
23.
HwangS, LeeYJ, KimKH, AhnCS, MoonDB, HaTY, et al. The Impact of Tumor Size on Long-Term Survival Outcomes After Resection of Solitary Hepatocellular Carcinoma: Single-Institution Experience with 2558 Patients. J Gastrointest Surg. 2015;19(7):1281–90.
24.
SchellhaasB,
BernatikT,
BohleW,
BorowitzkaF,
ChangJ,
DietrichCF, et al. Contrast-Enhanced Ultrasound Algorithms (CEUS-LIRADS/ESCULAP) for the Noninvasive Diagnosis of Hepatocellular Carcinoma - A Prospective Multicenter DEGUM Study. Ultraschall Med. 2021;42(2):e20.
25.
ZhouL, RuiJA, WangSB, ChenSG, QuQ. Clinicopathological predictors of poor survival and recurrence after curative resection in hepatocellular carcinoma without portal vein tumor thrombosis. Pathol Oncol Res. 2015;21(1):131–8.
26.
FengY, QinXC, LuoY,
LiYZ,
ZhouX. Efficacy of contrast-enhanced ultrasound washout rate in predicting hepatocellular
carcinoma differentiation. Ultrasound Med Biol. 2015Jun;41(6):1553–60.
27.
KimH,
ParkMS,
ChoiJY,
ParkYN,
KimMJ,
KimKS, et al. Can microvessel invasion of hepatocellular carcinoma be predicted by pre-operative MRI?Eur Radiol. 2009;19:1744–51.
28.
NishieA,
YoshimitsuK,
AsayamaY,
IrieH,
TajimaT,
HirakawaM, et al. Radiologic detectability of minute portal venous invasion in hepatocellular carcinoma. AJR. 2008;190:81–7.
