A Nomogram Based on Combining Clinical Features and Contrast Enhanced Ultrasound LI-RADS Improves Prediction of Microvascular Invasion in Hepatocellular Carcinoma

Hang Zhou; Jiawei Sun; Tao Jiang; Jiaqi Wu; Qunying Li; Chao Zhang; Ying Zhang; Jing Cao; Yu Sun; Yifan Jiang; Yajing Liu; Xianli Zhou; Pintong Huang

doi:10.3389/fonc.2021.699290

A Nomogram Based on Combining Clinical Features and Contrast Enhanced Ultrasound LI-RADS Improves Prediction of Microvascular Invasion in Hepatocellular Carcinoma

Front Oncol. 2021 Jul 8:11:699290. doi: 10.3389/fonc.2021.699290. eCollection 2021.

Authors

Hang Zhou¹, Jiawei Sun², Tao Jiang¹, Jiaqi Wu², Qunying Li¹, Chao Zhang¹, Ying Zhang¹, Jing Cao¹, Yu Sun¹, Yifan Jiang¹, Yajing Liu¹, Xianli Zhou², Pintong Huang¹

Affiliations

¹ Department of Ultrasound in Medicine, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
² Department of In-Patient Ultrasound, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.

Abstract

Purposes: To establish a predictive model incorporating clinical features and contrast enhanced ultrasound liver imaging and reporting and data system (CEUS LI-RADS) for estimation of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) patients.

Methods: In the retrospective study, 127 HCC patients from two hospitals were allocated as training cohort (n=98) and test cohorts (n=29) based on cutoff time-point, June 2020. Multivariate regression analysis was performed to identify independent indicators for developing predictive nomogram models. The area under receiver operating characteristic (AUC) curve was also determined to establish the diagnostic performance of different predictive models. Corresponding sensitivities and specificities of different models at the cutoff nomogram value were compared.

Results: In the training cohort, clinical information (larger tumor size, higher AFP level) and CEUS LR-M were significantly correlated with the presence of MVI (all p<0.05). By incorporating clinical information and CEUS LR-M, the predictive model (LR-M+Clin) achieved a desirable diagnostic performance (AUC=0.80 and 0.84) in both cohorts at nomogram cutoff score value of 89. The sensitivity of LR-M+Clin when predicting MVI in HCC patients was higher than that of the clinical model alone (86.7% vs. 46.7%, p=0.027), while specificities were 78.6% and 85.7% (p=0.06), respectively, in the test cohort. In addition, LR-M+Clin exhibited similar AUC and specificity, but a significantly higher sensitivity (86.7%) than those of LR-M alone and LR-5(No)+Clin (both sensitivities=73.3%, both p=0.048).

Conclusion: The predictive model incorporating CEUS LR-M and clinical features was able to predict the MVI status of HCC and is a potential reliable preoperative tool for informing treatment.

Keywords: contrast enhanced ultrasound; hepatocellular carcinoma; liver imaging and reporting and data system; microvascular invasion; nomogram.