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Liver Int. 2018 Jun;38(6):1055-1063. doi: 10.1111/liv.13611. Epub 2017 Nov 3.

Liver elastography malignancy prediction score for noninvasive characterization of focal liver lesions.

Author information

1
Department of Gastroenterology, Hepatology and Clinical Nutrition, University Hospital Dubrava, University of Zagreb School of Medicine and Faculty of Pharmacy and Biochemistry, Zagreb, Croatia.
2
Department of Gastroenterology and Hepatology, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina.
3
Department of Diagnostic and Interventional Radiology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia.
4
Department of Pathology and Cytology, University Hospital Dubrava, Zagreb, Croatia.
5
Faculty of Medicine, University "J.J. Strossmayer", Osijek, Croatia.
6
Department of Pathology and Cytology, University Hospital Dubrava, University of Zagreb School of Medicine, Zagreb, Croatia.
7
Department of Abdominal Surgery, University Hospital Dubrava, Zagreb, Croatia.
8
Department of Gastroenterology and Hepatology, University Hospital Merkur, University of Zagreb School of Medicine, Zagreb, Croatia.
9
Hepatology, Swiss Liver Center, University Clinic for Visceral Surgery and Medicine, Inselspital, University of Berne, Berne, Switzerland.

Abstract

BACKGROUND & AIMS:

To analyse elastographic characteristics of focal liver lesions (FLL)s and diagnostic performance of real-time two-dimensional shear-wave elastography (RT-2D-SWE) in order to differentiate benign and malignant FLLs.

METHODS:

Consecutive patients diagnosed with FLL by abdominal ultrasound (US) underwent RT-2D-SWE of FLL and non-infiltrated liver by intercostal approach over the right liver lobe. The nature of FLL was determined by diagnostic work-up, including at least one contrast-enhanced imaging modality (MDCT/MRI), check-up of target organs when metastatic disease was suspected and FLL biopsy in inconclusive cases.

RESULTS:

We analysed 196 patients (median age 60 [range 50-68], 50.5% males) with 259 FLLs (57 hepatocellular carcinomas, 17 cholangiocarcinomas, 94 metastases, 71 haemangiomas, 20 focal nodular hyperplasia) of which 70 (27%) were in cirrhotic liver. Malignant lesions were stiffer (P < .001) with higher variability in intralesional stiffness (P = .001). The best performing cut-off of lesion stiffness was 22.3 kPa (sensitivity 83%; specificity 86%; positive predictive value [PPV] 91.5%; negative predictive value [NPV] 73%) for malignancy. Lesion stiffness <14 kPa had NPV of 96%, while values >32.5 kPa had PPV of 96% for malignancy. Lesion stiffness, lesion/liver stiffness ratio and lesion stiffness variability significantly predicted malignancy in stepwise logistic regression (P < .05), and were used to construct a new Liver Elastography Malignancy Prediction (LEMP) score with accuracy of 96.1% in validation cohort (online calculator available at http://bit.do/lemps).

CONCLUSION:

The comprehensive approach demonstrated in this study enables correct differentiation of benign and malignant FLL in 96% of patients by using RT-2D-SWE.

KEYWORDS:

liver tumors; non-invasive diagnosis; shear wave elastography; ultrasound

PMID:
29028279
DOI:
10.1111/liv.13611
[Indexed for MEDLINE]

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