Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System in Hepatocellular Carcinoma ≤5 cm: Biological Characteristics and Patient Outcomes

Wen-Jia Cai; Minghua Ying; Rong-Qin Zheng; Jintang Liao; Baoming Luo; Lina Tang; Wen Cheng; Hong Yang; An Wei; Yilin Yang; Hui Wang; Yan-Chun Luo; Cun Liu; Hui Zhong; Qi Yang; Jie Yu; Ping Liang

doi:10.1159/000527498

Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System in Hepatocellular Carcinoma ≤5 cm: Biological Characteristics and Patient Outcomes

Liver Cancer. 2023 Jan 24;12(4):356-371. doi: 10.1159/000527498. eCollection 2023 Sep.

Authors

Wen-Jia Cai¹, Minghua Ying², Rong-Qin Zheng³, Jintang Liao⁴, Baoming Luo⁵, Lina Tang⁶, Wen Cheng⁷, Hong Yang⁸, An Wei⁹, Yilin Yang¹⁰, Hui Wang¹¹, Yan-Chun Luo¹, Cun Liu¹², Hui Zhong¹³, Qi Yang¹⁴, Jie Yu¹, Ping Liang¹

Affiliations

¹ Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
² Department of Diagnostic Ultrasound, Fifth Medical Center of Chinese PLA General Hospital, Beijing, China.
³ Department of Medical Ultrasound, Guangdong Key Laboratory of Liver Disease Research, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
⁴ Department of Diagnostic Ultrasound, Xiangya Hospital Central South University, Changsha, China.
⁵ Department of Ultrasound, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
⁶ Department of Diagnostic Ultrasound, Fujian Cancer Hospital and Fujian Medical University Cancer Hospital, Fuzhou, China.
⁷ Department of Ultrasound, Harbin Medical University Cancer Hospital, Harbin, China.
⁸ Department of Medical Ultrasound, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
⁹ Department of Interventional Ultrasound, Hunan Provincial People's Hospital, Changsha, China.
¹⁰ Department of Ultrasound Diagnosis, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
¹¹ Department of Ultrasound, China-Japan Union Hospital of Jilin University, Changchun, China.
¹² Department of Ultrasound, Jinan Central, Hospital Affiliated to Shandong First Medical University, Jinan, China.
¹³ Department of Biomedical Engineering, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China.
¹⁴ Department of Medical Ultrasound, Peking University Shenzhen Hospital, Shenzhen, China.

Abstract

Introduction: The present study aimed to evaluate the influence of biological characteristics of hepatocellular carcinoma (HCC) on the Liver Imaging Reporting and Data System (LI-RADS) v2017 category of contrast-enhanced ultrasound (CEUS) in patients with high risk and compare the outcomes among different categories after radical resection.

Methods: Between June 2017 and December 2020, standardized CEUS data of liver nodules were prospectively collected from multiple centers across China. We conducted a retrospective analysis of the prospectively collected data on HCCs measuring no more than 5 cm, as diagnosed by pathology. LI-RADS categories were assigned after thorough evaluation of CEUS features. Then, CEUS LI-RADS categories and major features were compared in different differentiation, Ki-67, and microvascular invasion (MVI) statuses. Differences in recurrence-free survival (RFS) among different LI-RADS categories were further analyzed.

Results: A total of 293 HCC nodules in 293 patients were included. This study revealed significant differences in the CEUS LI-RADS category of HCCs among differentiation (p < 0.001) and levels of Ki-67 (p = 0.01) and that poor differentiation (32.7% in LR-M, 12% in LR-5, and 6.2% in LR-4) (p < 0.001) and high level of Ki-67 (median value 30%) were more frequently classified into the LR-M category, whereas well differentiation (37.5% in LR-4, 15.1% in LR-5, and 11.5% in LR-M) and low levels of Ki-67 (median value 11%) were more frequently classified into the LR-4 category. No significant differences were found between MVI and CEUS LI-RADS categories (p > 0.05). With a median follow-up of 23 months, HCCs assigned to different CEUS LI-RADS classes showed no significant differences in RFS after resection.

Conclusions: Biological characteristics of HCC, including differentiation and level of Ki-67 expression, could influence major features of CEUS and impact the CEUS LI-RADS category. HCCs in different CEUS LI-RADS categories showed no significant differences in RFS after resection.

Keywords: Contrast-enhanced ultrasound; Hepatocellular carcinoma; Ki-67; Liver imaging reporting and data system; Prognosis.

Grants and funding

This work was supported by Grants 81971625, 91859201, 82102076, and 82030047 from the National Natural Science Foundation of China. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.