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Contrast-Enhanced Ultrasound May Help to Predict Cirrhotic Nodule Transformation to Hepatocellular Carcinoma


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An article published by Lin et al in the American Journal of Roentgenology has identified sonographic biomarkers that may predict eventual malignant transformation of pathologically confirmed cirrhotic nodules for patients at risk for hepatocellular carcinoma.

Lead investigator Manxia Lin, MD, of Sun Yat-Sen University, and colleagues retrospectively studied 39 consecutive patients with 44 pathologically confirmed cirrhotic nodules who initially underwent contrast-enhanced ultrasound examination at detection, followed by conventional ultrasound every 3 to 4 months thereafter. Malignant transformation was identified on the basis of noninvasive diagnostic criteria for hepatocellular carcinoma or rebiopsy, and malignant transformation biomarkers were identified from clinical and sonographic variables.

KEY POINTS

  • Fourteen nodules (31.8%) evidenced eventual malignant transformation after a median follow-up time of 26.7 months.
  • Sensitivity analysis revealed that an absolute growth rate of 5 mm or greater in 6 months or a relative growth rate of 30% or greater in 6 months could be considered as threshold growth for identifying malignant transformation.

Results

Fourteen nodules (31.8%) evidenced eventual malignant transformation after a median follow-up time of 26.7 months. At initial detection, nodule size and a contrast arrival time difference between the nodule and liver of more than a half-second were independent predictors for malignant transformation.

Sensitivity analysis revealed that an absolute growth rate of 5 mm or greater in 6 months or a relative growth rate of 30% or greater in 6 months could be considered as threshold growth for identifying malignant transformation (specificity = 100%; positive predictive value = 100%). 

According to the authors, the contrast arrival time difference between the cirrhotic nodule and the liver on contrast-enhanced ultrasound proved useful in stratifying eventual malignant transformation risk, “which may enable a more customized surveillance strategy,” they noted.

Moreover, the team determined that the absence of both echogenicity change and threshold growth “significantly excluded malignant transformation.”

Acknowledging that additional studies will be necessary for validating possible biomarkers, the authors concluded, “These additional imaging features may have the potential to be adopted as ancillary or even major features to stratify probability for hepatocellular in the contrast-enhanced ultrasound Liver Imaging Reporting and Data System (LI-RADS).”

Disclosure: For full disclosures of the study authors, visit ajronline.org.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
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