Prospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Sep 27, 2023; 15(9): 2042-2051
Published online Sep 27, 2023. doi: 10.4240/wjgs.v15.i9.2042
Preoperative prediction of microvascular invasion in hepatocellular carcinoma using ultrasound features including elasticity
Dong Jiang, Yi Qian, Bi-Bo Tan, Xia-Ling Zhu, Hui Dong, Rong Qian
Dong Jiang, Yi Qian, Bi-Bo Tan, Xia-Ling Zhu, Department of Ultrasound, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai 200438, China
Hui Dong, Department of Pathology, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai 200438, China
Rong Qian, Department of Ultrasound, No. 905 Hospital of PLA Navy, Shanghai 200052, China
Author contributions: Jiang D, Dong H, and Qian R designed the study; Qian Y, Tan BB, and Zhu XL performed the research and collected ultrasound data; Dong H reviewed and analyzed pathological specimens; Jiang D and Qian R performed statistical analysis; Jiang D and Qian R wrote the manuscript; All authors read and approved the final manuscript.
Supported by the Key Program of Science and Technology Commission Foundation of Changning, No. CNKW2022Y61.
Institutional review board statement: This prospective study was approved by the Ethics Committee of Eastern Hepatobiliary Surgery Hospital (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: Each patient provided written informed consent before the ultrasound examinations.
Conflict-of-interest statement: All authors confirm having no conflicts of interest.
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: Rong Qian, Doctor, MD, Chief Physician, Department of Ultrasound, No. 905 Hospital of PLA Navy, No. 1328 Huashan Road, Shanghai 200052, China. 2651184151@qq.com
Received: May 24, 2023
Peer-review started: May 24, 2023
First decision: June 12, 2023
Revised: June 23, 2023
Accepted: July 27, 2023
Article in press: July 27, 2023
Published online: September 27, 2023
Processing time: 121 Days and 8.5 Hours
Abstract
BACKGROUND

Microvascular invasion (MVI) is an important predictor of poor prognosis in patients with hepatocellular carcinoma (HCC). Accurate preoperative prediction of MVI in HCC would provide useful information to guide the choice of therapeutic strategy. Shear wave elastography (SWE) plays an important role in hepatic imaging, but its value in the preoperative prediction of MVI in HCC has not yet been proven.

AIM

To explore the value of conventional ultrasound features and SWE in the preoperative prediction of MVI in HCC.

METHODS

Patients with a postoperative pathological diagnosis of HCC and a definite diagnosis of MVI were enrolled in this study. Conventional ultrasound features and SWE features such as maximal elasticity (Emax) of HCCs and Emax of the periphery of HCCs were acquired before surgery. These features were compared between MVI-positive HCCs and MVI-negative HCCs and between mild MVI HCCs and severe MVI HCCs.

RESULTS

This study included 86 MVI-negative HCCs and 102 MVI-positive HCCs, including 54 with mild MVI and 48 with severe MVI. Maximal tumor diameters, surrounding liver tissue, color Doppler flow, Emax of HCCs, and Emax of the periphery of HCCs were significantly different between MVI-positive HCCs and MVI-negative HCCs. In addition, Emax of the periphery of HCCs was significantly different between mild MVI HCCs and severe MVI HCCs. Higher Emax of the periphery of HCCs and larger maximal diameters were independent risk factors for MVI, with odds ratios of 2.820 and 1.021, respectively.

CONCLUSION

HCC size and stiffness of the periphery of HCC are useful ultrasound criteria for predicting positive MVI. Preoperative ultrasound and SWE can provide useful information for the prediction of MVI in HCCs.

Keywords: Hepatocellular carcinoma; Microvascular invasion; Conventional ultrasound; Shear wave elastography

Core Tip: Shear wave elastography (SWE) plays an important role in differentiating benign and malignant liver tumors and different types of malignant liver tumors. However, its value in the preoperative prediction of microvascular invasion (MVI) in hepatocellular carcinoma (HCC) has not yet been proven. We used conventional ultrasound and SWE to evaluate the features of HCCs for preoperative prediction of MVI in HCCs. Our results showed that higher maximal elasticity of the periphery of HCCs and larger maximal diameters were independent risk factors for MVI. Preoperative conventional ultrasound and SWE can provide useful information for the prediction of MVI in HCCs.