Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2022; 28(32): 4716-4725
Published online Aug 28, 2022. doi: 10.3748/wjg.v28.i32.4716
Differential diagnosis of different types of solid focal liver lesions using two-dimensional shear wave elastography
Jia Guo, Dong Jiang, Yi Qian, Jiao Yu, Yi-Jun Gu, Yu-Qing Zhou, Hui-Ping Zhang
Jia Guo, Department of Ultrasound, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Dong Jiang, Yi Qian, Yi-Jun Gu, Department of Ultrasound, Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University, Shanghai 200433, China
Jiao Yu, Department of Infectious Diseases, Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University, Shanghai 200433, China
Yu-Qing Zhou, Hui-Ping Zhang, Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai 200050, China
Author contributions: Guo J and Jiang D contributed equally to this work; Guo J, Jiang D, Yu J and Zhang HP designed the study; Guo J, Jiang D, Qian Y and Gu YJ performed the research and collected data; Zhang HP and Zhou YQ performed statistical analysis; Guo J and Jiang D wrote the manuscript; all authors have read and approved the final manuscript.
Supported by Natural Science Foundation of Shanghai of China, No. 19ZR1441500, No. 22ZR1458200; Science Research Foundation of Shanghai Municipal Health Commission, No. 202140378; and Key Program of Science and Technology Commission Foundation of Changning, Shanghai, China, No. CNKW2020Z04.
Institutional review board statement: The study was approved by the Institutional Ethical Review Board of Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University (Approval No. EHBHKY2021-K-017).
Clinical trial registration statement: This study is registered at clinical hospital center ‘Eastern Hepatobiliary Surgery Hospital, Naval Medical University’ trial registry. The registration identification number is ChiCTR2100049831.
Informed consent statement: All patients provided written informed consent prior to study enrollment before ultrasound examinations.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
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: Hui-Ping Zhang, MD, PhD, Associate Chief Physician, Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, No. 786 Yuyuan Road, Shanghai 200050, China. zhanggirldan@163.com
Received: April 6, 2022
Peer-review started: April 6, 2022
First decision: June 27, 2022
Revised: July 15, 2022
Accepted: July 31, 2022
Article in press: July 31, 2022
Published online: August 28, 2022
ARTICLE HIGHLIGHTS
Research background

Conventional ultrasound is the first imaging choice for liver diseases with the diagnostic efficiency not good enough, which promotes the development of new ultrasound technologies, such as contrast enhanced ultrasound and ultrasound elastography. Two dimensional shear wave elastography (2D-SWE) is convenient, less time-consuming and inexpensive. SWE plays an important role in the assessment of liver fibrosis and in the differential diagnosis of benign and malignant focal liver lesions (FLLs). However, its value for the differential diagnosis among different types of malignant FLLs has not been proved.

Research motivation

Though the value of SWE for the differential diagnosis between malignant and benign FLLs was not widely recognized, our previous study showed promising results using maximal elasticity (Emax) as the parameter to differentiate malignant FLLs from benign ones. As the clinical management and prognosis of different pathological types of malignant FLLs are different, it is important to diagnose accurately of the possible pathological types. So, it was necessary to explore the value of 2D-SWE with Emax in differential diagnosis of different pathological types of malignant FLLs.

Research objectives

We aim to explore the value of 2D-SWE using Emax in the differential diagnosis of FLLs, especially among different pathological types of malignant FLLs.

Research methods

In this study, we diagnosed all FLLs as benign, malignant and undetermined using conventional ultrasound. And the stiffness of FLLs and the periphery of FLLs were evaluated using 2D-SWE and the quantitative parameter Emax. Emax of FLLs and the periphery of FLLs were compared between benign and malignant FLLs or among different pathological types of malignant FLLs.

Research results

There were totally 132 FFLs in 127 patients enrolled in the study, including 32 benign FLLs, 16 cholangiocellular carcinomas (CCCs), 72 hepatocellular carcinomas (HCCs) and 12 liver metastases. Thirty-five FLLs were diagnosed as undermined by conventional ultrasound. Emax of malignant FLLs (2.21 ± 0.57 m/s) were significantly higher than those of benign FLLs (1.59 ± 0.37 m/s) (P = 0.000). Emax of the periphery of malignant FLLs (1.52 ± 0.39 m/s) were significantly higher than those of benign FLLs (1.36 ± 0.44 m/s) (P = 0.040). The cut-off point of Emax of the tumors was 1.905 with AUC 0.843. The sensitivity, specificity and accuracy were 71.00%, 84.38% and 74.24% respectively using Emax > 1.905 m/s for diagnosis as malignant and 23 of 35 (65.74%) FLLs with undetermined diagnosis by conventional ultrasound were diagnosed correctly. Emax of liver metastases (2.73 ± 0.99 m/s) was significantly higher than that of primary liver carcinomas, including CCCs (2.14 ± 0.34 m/s) and HCCs (2.14 ± 0.46 m/s) (P = 0.002).

Research conclusions

Malignant FLLs were stiffer than benign ones and liver metastases were stiffer than primary liver carcinomas. 2D-SEW with Emax was a useful complement to conventional ultrasound for the differential diagnosis of FLLs.

Research perspectives

In this study, we demonstrated the differences of 2D-SWE with Emax between benign and malignant FLLs and among different pathological types of malignant FLLs. Prospective study to explore the value of 2D-SWE with Emax in the evaluatation the different stiffness of liver metastases from different sources or the different stiffness of HCC with different microvascular invasion grade will be necessary.