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 18 October 2017

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News

Diagnostic accuracy of contrast-enhanced ultrasound for the differential diagnosis of liver cancer

A study in the latest issue of the European Journal of Gastroenterology & Hepatology compares the diagnostic accuracy of contrast-enhanced ultrasound algorithms for the differential diagnosis of hepatocellular carcinoma.

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Dr Barbara Schellhaas compared 2 contrast-enhanced ultrasound algorithms for the diagnosis of hepatocellular carcinoma in high-risk patients, including Erlanger Synopsis of Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at Risk (ESCULAP) and American College of Radiology Contrast-Enhanced Ultrasound-Liver Imaging Reporting and Data System.

Focal liver lesions in 100 high-risk patients were assessed using both contrast-enhanced ultrasound algorithms for a direct comparison.

The team categorized lesions according to size and contrast enhancement in the arterial, portal venous and late phases.

For the definite diagnosis of hepatocellular carcinoma, categories ESCULAP-4, ESCULAP-Tr and ESCULAP-V and contrast-enhanced ultrasound-LI-RADS-LR-5, LR-Tr and LR-5-V were compared.

The diagnostic accuracy for intrahepatic cholangiocellular carcinoma was identical with both algorithms
European Journal of Gastroenterology & Hepatology

In addition, contrast-enhanced ultrasound-LI-RADS-category LR-M, and ESCULAP-category C were compared.

Histology, ontrast-enhanced-computed tomography and ontrast-enhanced-MRI served as reference standards.

The researchers found that the reference standard among 100 lesions included 87 hepatocellular carcinomas, 6 intrahepatic cholangiocellular carcinomas and 7 non-hepatocellular carcinoma-non-intrahepatic cholangiocellular carcinoma-lesions.

For the diagnosis of hepatocellular carcinoma, the team noted that the diagnostic accuracy of contrast-enhanced ultrasound was significantly higher with ESCULAP versus contrast-enhanced ultrasound-LI-RADS.

The researchers observed that the sensitivity, specificity and positive predictive value and negative predictive value for ESCULAP/contrast-enhanced ultrasound-LI-RADS were 94%/72%; 62%/69%; 94%/94%; and 62%/27%, respectively.

The diagnostic accuracy for intrahepatic cholangiocellular carcinoma was identical with both algorithms, with higher positive predictive value for ESCULAP-C versus LR-M.

Dr Schellhaas' team concludes, "Contrast-enhanced ultrasound-based algorithms contribute toward standardized assessment and reporting of hepatocellular carcinoma-suspect lesions in high-risk patients."

"ESCULAP shows significantly higher diagnostic accuracy, sensitivity and negative predictive value with no loss of specificity compared with contrast-enhanced ultrasound-LI-RADS."

"Both algorithms have an excellent positive predictive value."

"Arterial hyperenhancement is the key feature for the diagnosis of hepatocellular carcinoma with contrast-enhanced ultrasound."

"Washout should not be a necessary prerequisite for the diagnosis of definite hepatocellular carcinoma."

"Contrast-enhanced ultrasound-LI-RADS in its current version is inferior to ESCULAP for the noninvasive diagnosis of hepatocellular carcinoma."

"There are 2 ways to improve contrast-enhanced ultrasound-LI-RADS, including the combination of the categories LR-4 and LR-5 for the diagnosis of definite hepatocellular carcinoma, and the use of subtotal infiltration of a liver lobe as an additional feature."

Eur J Gastroenterol Hepatol 2017: 29(9): 1036–1044
04 September 2017

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