Observational Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2019; 11(12): 1193-1205
Published online Dec 15, 2019. doi: 10.4251/wjgo.v11.i12.1193
Multi-parameter ultrasound based on the logistic regression model in the differential diagnosis of hepatocellular adenoma and focal nodular hyperplasia
Meng Wu, Ru-Hai Zhou, Feng Xu, Xian-Peng Li, Ping Zhao, Rui Yuan, Yu-Peng Lan, Wei-Xia Zhou
Meng Wu, Ru-Hai Zhou, Feng Xu, Xian-Peng Li, Ping Zhao, Rui Yuan, Yu-Peng Lan, Wei-Xia Zhou, Department of Ultrasound, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
Feng Xu, Xian-Peng Li, Department of Gastroenterology, Yinzhou Hospital Affiliated to Ningbo University School of Medicine, Ningbo 315000, Zhejiang Province, China
Author contributions: Wu M, Zhou RH, Xu F, Li XP, Zhao P and Yuan R designed research; Wu M, Xu F, Zhao P and Lan YP performed research; Lan YP and Zhou WX contributed new analytic tools; Zhou RH, Li XP, Yuan R and Zhou WX analyzed data; and Wu M, Zhou RH, Xu F, Lan YP and Zhou WX wrote the paper.
Supported by Zhejiang Natural Science Foundation, NO. LY16H160004; Ningbo Yinzhou District Agricultural and Social Development Science and Technology Project, NO. Yinke 2018-74.
Institutional review board statement: The study was approved by the ethics committee of Yinzhou Hospital affiliated to Ningbo University School of Medicine.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: None of the authors have any conflict of interest to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Meng Wu, MD, Doctor, Department of Ultrasound, Yinzhou Hospital affiliated to Ningbo University School of Medicine, No. 251 Baizhang East Road, Ningbo 315040, Zhejiang Province, China. wumengcool@sina.com
Telephone: +86-574-87017240
Received: June 15, 2019
Peer-review started: June 18, 2019
First decision: July 31, 2019
Revised: August 13, 2019
Accepted: September 10, 2019
Article in press: September 10, 2019
Published online: December 15, 2019
Processing time: 179 Days and 18.6 Hours
Abstract
BACKGROUND

Focal nodular hyperplasia (FNH) has very low potential risk, and a tendency to spontaneously resolve. Hepatocellular adenoma (HCA) has a certain malignant tendency, and its prognosis is significantly different from FNH. Accurate identification of HCA and FNH is critical for clinical treatment.

AIM

To analyze the value of multi-parameter ultrasound index based on logistic regression for the differential diagnosis of HCA and FNH.

METHODS

Thirty-one patients with HCA were included in the HCA group. Fifty patients with FNH were included in the FNH group. The clinical data were collected and recorded in the two groups. Conventional ultrasound, shear wave elastography, and contrast-enhanced ultrasound were performed, and the lesion location, lesion echo, Young’s modulus (YM) value, YM ratio, and changes of time intense curve (TIC) were recorded. Multivariate logistic regression analysis was used to screen the indicators that can be used for the differential diagnosis of HCA and FNH. A ROC curve was established for the potential indicators to analyze the accuracy of the differential diagnosis of HCA and FNH. The value of the combined indicators for distinguishing HCA and FNH were explored.

RESULTS

Multivariate logistic regression analysis showed that lesion echo (P = 0.000), YM value (P = 0.000) and TIC decreasing slope (P = 0.000) were the potential indicators identifying HCA and FNH. In the ROC curve analysis, the accuracy of the YM value distinguishing HCA and FNH was the highest (AUC = 0.891), which was significantly higher than the AUC of the lesion echo and the TIC decreasing slope (P < 0.05). The accuracy of the combined diagnosis was the highest (AUC = 0.938), which was significantly higher than the AUC of the indicators diagnosing HCA individually (P < 0.05). This sensitivity was 91.23%, and the specificity was 83.33%.

CONCLUSION

The combination of lesion echo, YM value and TIC decreasing slope can accurately differentiate between HCA and FNH.

Keywords: Hepatocellular adenoma; Focal nodular hyperplasia; Ultrasound; Logistic regression

Core tip: The prognosis of hepatocellular adenoma (HCA) is significantly different from focal nodular hyperplasia (FNH). Accurate identification of HCA and FNH is of great significance. This study explored the accuracy of the combined detection of HCA and FNH by conventional ultrasound, shear wave elastography, and contrast-enhanced ultrasound. The combination of lesion echo, Young’s modulus value and time intense curve decreasing slop in multi-parameter ultrasound index based on logistic regression has high clinical guiding value for the differential diagnosis of HCA and FNH.