Published online Jan 21, 2025. doi: 10.3748/wjg.v31.i3.98758
Revised: November 22, 2024
Accepted: December 2, 2024
Published online: January 21, 2025
Processing time: 168 Days and 11.4 Hours
This letter critically evaluates Jiang et al's article on the differentiation of benign and malignant liver lesions using Emax and platelet count. Despite notable findings, significant methodological and interpretative limitations are identified. The study lacks detailed assay conditions for Emax measurement, employs inadequate statistical methods without robust multivariate analysis, and does not provide clinically relevant threshold values. The nomogram's reliance on Emax as a major diagnostic contributor is questionable due to attenuation in hepatocellular carcinoma patients with cirrhosis. Moreover, the study's limitations, such as selection bias and confounding factors, are not adequately addressed. Future research should adopt more rigorous methodologies, including prospective studies with larger cohorts and standardized protocols for biomarker mea
Core Tip: This letter critically analyzes the Jiang et al's study to differentiate benign and malignant liver lesions using Emax and platelet count, but faces critical methodological issues. The lack of transparency in Emax measurement, inadequate control for confounding variables, and absence of clinically relevant thresholds limit the study’s practical applicability. The nomogram's heavy reliance on Emax is questionable due to its attenuation in hepatocellular carcinoma patients with cirrhosis, further confounding the results. Future research should employ rigorous methodologies, including larger, diverse cohorts and standardized protocols, to validate these biomarkers' clinical utility and ensure their reliability in practice.