Diagnostic Accuracy of Ultrasonography in Detection of Hepatocellular Carcinoma in Patients with Chronic Liver Disease Taking CT as Gold Standard
DOI:
https://doi.org/10.70749/ijbr.v3i4.2960Keywords:
UltrasoundAbstract
Objective: To determine the diagnostic accuracy of ultrasound in detecting hepatocellular carcinoma (HCC) among patients with chronic liver disease (CLD), using contrast-enhanced computed tomography (CECT) as the gold standard. Methods: This cross-sectional diagnostic accuracy study was conducted at the Department of Radiology, PAF Hospital Islamabad. A total of 129 patients with CLD and focal hepatic lesions on ultrasound were included. Ultrasound findings were compared with CECT findings. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated. Stratified analysis was performed for potential confounders. Results: The mean age was 53.40 ± 14.15 years. On CECT, 64 (49.6%) lesions were malignant. Ultrasound demonstrated sensitivity of 82.8%, specificity of 92.3%, PPV of 91.4%, NPV of 84.5%, and overall diagnostic accuracy of 87.6%. Stratified analysis showed consistently high diagnostic performance across age, gender, duration of CLD, etiology, Child-Pugh class, and lesion number. Conclusion: Ultrasound demonstrates high diagnostic accuracy in detecting HCC in CLD patients and remains a reliable, cost-effective first-line imaging modality in resource-limited settings.
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1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021; 71:209-49.
https://doi.org/10.3322/caac.21660.
2. Hafeez M, Nadeem M, Ahmed M, Faheem-ur-Rehman. Hepatocellular Carcinoma (HCC), Where do we stand? Current situation. Pak J Med Sci. 2020;36(3):344-348.
https://doi.org/10.12669/pjms.36.3.1594
3. Gnyawali B, Pusateri A, Nickerson A, Jalil S, Mumtaz K. Epidemiologic and socioeconomic factors impacting hepatitis B virus and related hepatocellular carcinoma. World J Gastroenterol. 2022 Aug 7;28(29):3793-3802.
https://doi.org/10.3748/wjg.v28.i29.3793.
4. Sithole WC, Pillay S, Mbanjwa B, Magula N. A convoluted path to the diagnosis of hepatocellular carcinoma in a resource-limited setting. SAGE Open Med Case Rep. 2023 Apr 25; 11:2050313X231168292.
https://doi.org/10.1177/2050313X231168292.
5. Nowicki TK, Markiet K, Szurowska E. Diagnostic Imaging of Hepatocellular Carcinoma - A Pictorial Essay. Curr Med Imaging Rev. 2017 May;13(2):140-153.
https://doi.org/10.2174/1573405612666160720123748.
6. Jiang HY, Chen J, Xia CC, Cao LK, Duan T, Song B. Noninvasive imaging of hepatocellular carcinoma: From diagnosis to prognosis. World J Gastroenterol. 2018 Jun 14;24(22):2348-2362.
https://doi.org/10.3748/wjg.v24.i22.2348.
7. Tanaka H. Current role of ultrasound in the diagnosis of hepatocellular carcinoma. J Med Ultrason (2001). 2020 Apr;47(2):239-255.
https://doi.org/10.1007/s10396-020-01012-y.
8. Maruyama H, Takahashi M, Ishibashi H, Yoshikawa M, Yokosuka O. Contrast-enhanced ultrasound for characterisation of hepatic lesions appearing non-hypervascular on CT in chronic liver diseases. Br J Radiol. 2012 Apr;85(1012):351-7.
https://doi.org/10.1259/bjr/20440141.
9. Arif QUA, Jabeen M, Siddiqui U, Irshad TM, Khan MB, Tahir S. Diagnostic Accuracy of Ultrasound in Detecting Hepatocellular Carcinoma Keeping Histopathology as Gold Standard. Ann Pak Inst Med Sci. 2021; 17(2):168-173.
https://doi.org/10.48036/apims.v17i2.368
10. Aslam A, Nazir M, Zain ul Abidin S, Fatima Z, Yousaf Farooq SM, Zia S, et al. Diagnostic accuracy of ultrasound for benign and malignant hepatic masses taking computed tomography as gold standard. Pak J Health Sci. 2022;3(6).
https://doi.org/10.54393/pjhs.v3i06.269
11. Butt AS, Abbas Z, Jafri W. Hepatocellular Carcinoma in Pakistan; Where do We Stand?. Hepat Mon. 2012;12(10 HCC): e6023.
https://doi.org/10.5812/hepatmon.6023
12. Qureshi H, Bile KM, Jooma R, Alam SE, Afridi HU. Prevalence of hepatitis B and C viral infections in Pakistan: findings of a national survey appealing for effective prevention and control measures. East Mediterr Health J. 2010;16 Suppl:S15-23. PMID: 21495584..
13. Singal AG, Pillai A, Tiro J. Early detection, curative treatment, and survival rates for hepatocellular carcinoma surveillance in patients with cirrhosis: a meta-analysis. PLoS Med. 2014 Apr 1;11(4):e1001624.
https://doi.org/10.1371/journal.pmed.1001624.
14. Colli A, Fraquelli M, Casazza G, Massironi S, Colucci A, Conte D, Duca P. Accuracy of ultrasonography, spiral CT, magnetic resonance, and alpha-fetoprotein in diagnosing hepatocellular carcinoma: a systematic review. Am J Gastroenterol. 2006 Mar;101(3):513-23.
https://doi.org/10.1111/j.1572-0241.2006.00467.x.
15. Tzartzeva K, Obi J, Rich NE, Parikh ND, Marrero JA, Yopp A, Waljee AK, et al. Surveillance Imaging and Alpha Fetoprotein for Early Detection of Hepatocellular Carcinoma in Patients With Cirrhosis: A Meta-analysis. Gastroenterology. 2018 May;154(6):1706-1718.e1.
https://doi.org/10.1053/j.gastro.2018.01.064.
16. Obaro AE, Ryan SM. Benign liver lesions: grey-scale and contrast-enhanced ultrasound appearances. Ultrasound. 2015 May;23(2):116-25.
https://doi.org/10.1177/1742271X15575805.
17. Chartampilas E, Rafailidis V, Georgopoulou V, Kalarakis G, Hatzidakis A, Prassopoulos P. Current Imaging Diagnosis of Hepatocellular Carcinoma. Cancers (Basel). 2022 Aug 18;14(16):3997.
https://doi.org/10.3390/cancers14163997.
18. Simmons O, Fetzer DT, Yokoo T, Marrero JA, Yopp A, Kono Y, Parikh ND, Browning T, Singal AG. Predictors of adequate ultrasound quality for hepatocellular carcinoma surveillance in patients with cirrhosis. Aliment Pharmacol Ther. 2017 Jan;45(1):169-177.
https://doi.org/10.1111/apt.13841.
19. Singh S, Hoque S, Zekry A, Sowmya A. Radiological Diagnosis of Chronic Liver Disease and Hepatocellular Carcinoma: A Review. J Med Syst. 2023 Jul 11;47(1):73.
https://doi.org/10.1007/s10916-023-01968-7.
20. Nishikawa H, Enomoto H, Ishii A, Iwata Y, Miyamoto Y, Ishii N, et al. Comparison of Prognostic Impact between the Child-Pugh Score and Skeletal Muscle Mass for Patients with Liver Cirrhosis. Nutrients. 2017 Jun 12;9(6):595.
https://doi.org/10.3390/nu9060595.
21. Spârchez Z, Crăciun R, Nenu I, Mocan LP, Spârchez M, Mocan T. Refining Liver Biopsy in Hepatocellular Carcinoma: An In-Depth Exploration of Shifting Diagnostic and Therapeutic Applications. Biomedicines. 2023 Aug 21;11(8):2324.
https://doi.org/10.3390/biomedicines11082324.
22. Silva MA, Hegab B, Hyde C, Guo B, Buckels JA, Mirza DF. Needle track seeding following biopsy of liver lesions in the diagnosis of hepatocellular cancer: a systematic review and meta-analysis. Gut. 2008 Nov;57(11):1592-6.
https://doi.org/10.1136/gut.2008.149062.
23. Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, et al. Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2018 Aug;68(2):723-750.
https://doi.org/10.1002/hep.29913.
24. European Association for the Study of the Liver. EASL clinical practice guidelines: management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182-236.
https://doi.org/10.1016/j.jhep.2018.03.019
25. Llovet JM, Zucman-Rossi J, Pikarsky E, Sangro B, Schwartz M, Sherman M, Gores G. Hepatocellular carcinoma. Nat Rev Dis Primers. 2016 Apr 14;2:16018.
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