Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 7, 2022; 28(21): 2350-2360
Published online Jun 7, 2022. doi: 10.3748/wjg.v28.i21.2350
Differentiating malignant and benign focal liver lesions in children using CEUS LI-RADS combined with serum alpha-fetoprotein
Zhen-Peng Jiang, Ke-Yu Zeng, Jia-Yan Huang, Jie Yang, Rui Yang, Jia-Wu Li, Ting-Ting Qiu, Yan Luo, Qiang Lu
Zhen-Peng Jiang, Ke-Yu Zeng, Jia-Yan Huang, Jie Yang, Rui Yang, Jia-Wu Li, Ting-Ting Qiu, Yan Luo, Qiang Lu, Department of Medical Ultrasound, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Jiang ZP and Lu Q designed the research; Jiang ZP, Li JW, Qiu TT, Luo Y and Lu Q performed the research; Jiang ZP, Zeng KY, Huang JY, Yang J and Yang R collected the data; Jiang ZP and Lu Q drafted the manuscript and review the literatures; Luo Y and Lu Q revised the manuscript; all authors contributed to approval of final version of submitted manuscript and agree to ensure that any questions related to the work are appropriately resolved.
Supported by the National Natural Science Foundation of China, No. 81571697; and the Science and Technology Department of Sichuan Province, No.2017SZ003 and No. 2018FZ0044.
Institutional review board statement: The study was reviewed and approved by the West China Hospital of Sichuan University Institutional Review Board.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at luqiang@scu.edu.cn.
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: Qiang Lu, MD, Professor, Department of Medical Ultrasound, West China Hospital of Sichuan University, No. 37 Guoxue Xiang, Chengdu 610041, Sichuan Province, China. luqiang@scu.edu.cn
Received: December 10, 2021
Peer-review started: December 10, 2021
First decision: January 27, 2022
Revised: February 8, 2022
Accepted: April 21, 2022
Article in press: April 21, 2022
Published online: June 7, 2022
Processing time: 173 Days and 21.9 Hours
Abstract
BACKGROUND

Contrast-enhanced ultrasound (CEUS) can be used to diagnose focal liver lesions (FLLs) in children. The America College of Radiology developed the CEUS liver imaging reporting and data system (LI-RADS) for standardizing CEUS diagnosis of FLLs in adult patients. Until now, no similar consensus or guidelines have existed for pediatric patients to improve imaging interpretation as adults.

AIM

To evaluate the performance of CEUS LI-RADS combined with alpha-fetoprotein (AFP) in differentiating benign and malignant FLLs in pediatric patients.

METHODS

Between January 2011 and January 2021, patients ≤ 18 years old who underwent CEUS for FLLs were retrospectively evaluated. The following criteria for diagnosing malignancy were proposed: Criterion I considered LR-4, LR-5, or LR-M lesions as malignancies; criterion II regarded LR-4, LR-5 or LR-M lesions with simultaneously elevated AFP (≥ 20 ng/mL) as malignancies; criterion III took LR-4 Lesions with elevated AFP or LR-5 or LR-M lesions as malignancies. The sensitivity, specificity, accuracy and area under the receiver operating characteristic curve (AUC) were calculated to determine the diagnostic value of the aforementioned criteria.

RESULTS

The study included 63 nodules in 60 patients (mean age, 11.0 ± 5.2 years; 26 male). There were no statistically significant differences between the specificity, accuracy, or AUC of criterion II and criterion III (95.1% vs 80.5%, 84.1% vs 87.3%, and 0.794 vs 0.902; all P > 0.017). Notably, criterion III showed a higher diagnostic sensitivity than criterion II (100% vs 63.6%; P < 0.017). However, both the specificity and accuracy of criterion I was inferior to those of criterion II and criterion III (all P < 0.017). For pediatric patients more than 5 years old, the performance of the three criteria was overall similar when patients were subcategorized by age when compared to all patients in aggregate.

CONCLUSION

CEUS LI-RADS combined with AFP may be a powerful diagnostic tool in pediatric patients. LR-4 with elevated AFP, LR-5 or LR-M lesions is highly suggestive of malignant tumors.

Keywords: Pediatric; Contrast-enhanced ultrasound; Liver imaging reporting and data system; Diagnosis; Focal liver lesions; Alpha-fetoprotein

Core Tip: Contrast-enhanced ultrasound liver imaging reporting and data system (CEUS LI-RADS) is used for the diagnosis of focal liver lesions (FLLs) in adult patients at high risk of hepatocellular carcinoma. CEUS has recently been approved to be used in characterization of FLLs in children. Our study investigated the diagnostic value of CEUS LI-RADS in association with serum alpha-fetoprotein (AFP) in differentiating malignant from benign FLLs in pediatric patients. Our study demonstrated that CEUS LI-RADS combined with AFP may be a powerful diagnostic tool for pediatric patients. LR-4 with elevated AFP, LR-5 or LR-M lesions are highly indicative of malignant tumors.