Clinical screening value of contrast-enhanced ultrasound combined with alpha-fetoprotein de-termination for hepatocellular carcinoma in high risk population
Objective To explore the value of contrast-enhanced ultrasound(CEUS)combined with alpha-fetoprotein(AFP)in screening hepatocellular carcinoma(HCC)in high risk population.Methods Clinical data of 138 focal hepatic lesions in 117 patients at high risk of HCC in our hospital from June 2018 to February 2020 were collected.Using pathological findings as the gold standard,the lesions were divided into a HCC group,a non-HCC malignant group and a benign group.Serum AFP levels and conventional ultrasound characteristics were compared among the three groups.The liver Imaging Reporting and Data System(CEUS-LI-RADS)was used to classify the lesions.The diagnostic value of AFP,conventional ultrasound,CEUS-LR4,5,and CEUS-LR5 in high risk population for HCC was analyzed.Results There were a total of 138 lesions in the 117 patients.Pathological analysis confirmed that 77 patients(87 lesions)were diagnosed as HCC,13 patients(16 lesions)as non-HCC malignant tumors and 27 patients(35 lesions)as benign nodules.The AFP levels in the HCC group was higher than the non-HCC malignant group and the benign group,and the non-HCC malignant group was higher than the benign group(P<0.05).The proportion of irregular shape,unclear boundary,low echo and lesion size≥3 cm in the HCC group and the non-HCC malignant group were higher than those in the benign group,and the proportion of rich central blood flow in the HCC group was lower than that in the non-HCC malignant group and the benign group(P<0.05).There were 3 lesions with LR1(2.17%),9 with LR2(6.52%),29 with LR3(21.01%),13 with LR4(9.42%),68 with LR5(49.28%)and 16 with LR-M(11.59%)by using CEUS-LI-RADS classification.The AUC(95%CI)of ROC curve analysis for conventional ultrasound,CEUS-LR4,5 and CEUS-LR5 in the diagnosis of HCC in high-risk populations were 0.747,0.870 and 0.823,respectively.The AUC(95%CI)of CEUS-LR4 and 5 combined with AFP in the diagnosis of HCC in high-risk populations was 0.923,which was significantly higher than the sensitivity,specificity,Jorden index and AUC of single diagnosis.Conclusions The screening effect of CEUS-LR4 and 5 classifications on HCC in high-risk population is better than that of CEUS-LR5 classification.CEUS-LR4 and 5 classifications combined with AFP detection is more valuable for HCC screening in high-risk popula-tion.
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