Clin Mol Hepatol.  2017 Mar;23(1):57-65. 10.3350/cmh.2016.0041.

A lexicon for hepatocellular carcinoma surveillance ultrasonography: benign versus malignant lesions

• An C
• Rakhmonova G
• Han K
• Seo N
• Lee JY
• Kim MJ
• Park MS

• KMID: 2412115
• DOI: http://doi.org/10.3350/cmh.2016.0041

Abstract

BACKGROUND/AIMS
To suggest a lexicon for liver ultrasonography and to identify radiologic features indicative of benign or malignant lesions on surveillance ultrasonography.
METHODS
This retrospective study included 188 nodules (benign, 101; malignant, 87) from 175 at-risk patients identified during surveillance ultrasonography for hepatocellular carcinoma. We created a lexicon for liver ultrasonography by reviewing relevant literature regarding the ultrasonographic features of hepatic lesions. Using this lexicon, two abdominal radiologists determined the presence or absence of each ultrasonographic feature for the included hepatic lesions. Independent factors associated with malignancy and interobserver agreement were determined by logistic regression analysis and kappa statistics, respectively.
RESULTS
Larger tumor size (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.06-1.183; P < 0.001), multinodular confluent morphology (OR, 7.712; 95% CI, 1.053-56.465; P=0.044), thick hypoechoic rim (OR, 5.878; 95% CI, 2.681-12.888; P < 0.001), and posterior acoustic enhancement (OR, 3.077; 95% CI, 1.237-7.655; P=0.016) were independently associated with malignant lesions. In a subgroup analysis of lesions <2 cm, none of the ultrasonographic features were significantly associated with malignancy or benignity. Interobserver agreement for morphology was fair (κ=0.36), while those for rim (κ=0.427), echogenicity (κ=0.549), and posterior acoustic enhancement (κ=0.543) were moderate.
CONCLUSIONS
For hepatic lesions larger than 2 cm, some ultrasonography (US) features might be suggestive of malignancy. We propose a lexicon that may be useful for surveillance US.

Keyword

Carcinoma, Hepatocellular; Surveillance; Ultrasonography

MeSH Terms

Adult
Aged
Carcinoma, Hepatocellular/complications/*diagnostic imaging
Contrast Media/chemistry
Diagnosis, Differential
Female
Hepatitis B/complications
Humans
Liver/diagnostic imaging
Liver Neoplasms/complications/*diagnostic imaging
Magnetic Resonance Imaging
Male
Middle Aged
Multivariate Analysis
Odds Ratio
Retrospective Studies
Sensitivity and Specificity
Tomography, X-Ray Computed
Ultrasonography
alpha-Fetoproteins/analysis
Contrast Media
alpha-Fetoproteins