CEUS LI-RADS in Combination With the Serum Biomarker-Based ASAP Model Improves the Diagnostic Performance of HCC in
Rong Wen1, Yuting Peng2, Yiqiong Liang3
1Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Insights
Combining Contrast-Enhanced Ultrasound (CEUS) LI-RADS with the ASAP model significantly improves the detection of hepatocellular carcinoma (HCC) in high-risk patients. This enhanced diagnostic approach boosts sensitivity for identifying HCC without compromising specificity or positive predictive value.
Area of Science:
- Radiology
- Hepatology
- Oncology
Background:
- Hepatocellular carcinoma (HCC) diagnosis in high-risk patients relies on imaging.
- Contrast-Enhanced Ultrasound (CEUS) with LI-RADS is a key diagnostic tool.
- Improving diagnostic accuracy for HCC remains a clinical challenge.
Purpose of the Study:
- To evaluate the diagnostic efficacy of CEUS LI-RADS combined with the ASAP model for HCC detection.
- To assess improvements in sensitivity, specificity, and PPV for HCC diagnosis.
- To refine diagnostic criteria for liver lesions in high-risk individuals.
Main Methods:
- Retrospective analysis of 366 liver lesions in 366 patients undergoing CEUS.
- Characterization and categorization using CEUS LI-RADS v2017.
- Modified LR-5 criteria incorporating AFP (Criterion 2) or ASAP model score and CA 19-9 (Criterion 3) were applied.
- Diagnostic performance evaluated against histopathology or comprehensive imaging and follow-up.
Main Results:
- The incidence of HCC varied across CEUS LI-RADS categories (LR-3: 33.3%, LR-4: 86.4%, LR-5: 98.5%, LR-M: 82.7%).
- Criterion 2 (AFP > 200 ng/mL) increased LR-5 sensitivity for HCC from 60.8% to 70.7% (p < 0.01) with minimal impact on specificity and PPV.
- Criterion 3 (ASAP model score > 0.5256 and normal CA 19-9) further improved LR-5 sensitivity to 86.9% (p < 0.01), maintaining specificity and PPV.
Conclusions:
- CEUS LI-RADS combined with the ASAP model enhances the diagnosis of HCC in high-risk patients.
- The ASAP model significantly improves the sensitivity of LR-5 for HCC detection.
- This combined approach offers a more accurate diagnostic strategy for HCC.
Objective:
To assess the diagnostic efficacy of the CEUS LI-RADS combined with a model constructed on the basis of age, sex, AFP, and PIVKA-II (ASAP) for the diagnosis of HCC in high-risk patients.
Methods:
This retrospective study included 366 liver lesions from 366 patients who underwent liver CEUS. All liver lesions were characterized and categorized according to CEUS LI-RADS v2017. Two modified methods were applied: LR-3/4/M nodules accompanied by AFP > 200 ng/mL (Criterion 2) or ASAP model score > 0.5256 and CA 19-9 in the normal range (Criterion 3) were recategorized as LR-5. The reference criteria included histopathological or comprehensive imaging and the clinical follow-up results. The diagnostic performance was evaluated and compared by the sensitivity, specificity, PPV, and NPV.
Results:
The incidence of HCC in LR-3, LR-4, LR-5, and LR-M was 33.3% (4/12), 86.4% (38/44), 98.5% (191/194) and 82.7% (81/98), respectively. After using Criterion 2 compared to CEUS LI-RADS v2017, the sensitivity of the modified LR-5 for diagnosing HCC increased from 60.8% to 70.7% (p < 0.01) with little effect on its specificity (94.2% vs. 92.3%, p = 1.00) or PPV (98.5% vs. 98.2%, p = 0.86). After using Criterion 3, the sensitivity of the modified LR-5 for the diagnosis of HCC was further improved to 86.9% (p < 0.01), and its specificity and PPV were not significantly changed (92.3% and 98.6%, both p > 0.05).
Conclusion:
CEUS LI-RADS combined with the serum biomarker-based ASAP model improved the sensitivity of LR-5 in diagnosing HCC with little effect on its specificity and PPV.
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