Letter to the Editor
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jan 21, 2025; 31(3): 98758
Published online Jan 21, 2025. doi: 10.3748/wjg.v31.i3.98758
Can Emax and platelet count truly differentiate between benign and malignant liver lesions?
Manjeet Kumar Goyal, Omesh Goyal
Manjeet Kumar Goyal, Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, New Delhi 110029, Delhi, India
Omesh Goyal, Department of Gastroenterology, Dayanand Medical College and Hospital, Ludhiana 141001, Punjab, India
Author contributions: Goyal MK was responsible for conceptualization, formal analysis, investigation, supervision, validation, visualization, writing-original draft, and writing-review & editing; Goyal O was responsible for conceptualization, data curation, formal analysis, validation, visualization, writing-original draft, and writing-review & editing.
Conflict-of-interest statement: Both authors have nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Manjeet Kumar Goyal, DM, DNB, MBBS, MD, Academic Fellow, Academic Research, Postdoctoral Fellow, Department of Gastroenterology and Human Nutrition Unit, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi 110029, Delhi, India. manjeetgoyal@gmail.com
Received: July 4, 2024
Revised: November 22, 2024
Accepted: December 2, 2024
Published online: January 21, 2025
Processing time: 168 Days and 11.4 Hours
Abstract

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 measurement, to enhance validity and clinical applicability.

Keywords: Emax; Platelet count; Benign liver lesions; Malignant liver lesions; Hepatocellular carcinoma; Cirrhosis; Diagnostic biomarkers; Shear wave elastography; Methodological limitations; Clinical utility

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.