Prospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Aug 28, 2022; 28(32): 4716-4725
Published online Aug 28, 2022. doi: 10.3748/wjg.v28.i32.4716
Differential diagnosis of different types of solid focal liver lesions using two-dimensional shear wave elastography
Jia Guo, Dong Jiang, Yi Qian, Jiao Yu, Yi-Jun Gu, Yu-Qing Zhou, Hui-Ping Zhang
Jia Guo, Department of Ultrasound, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
Dong Jiang, Yi Qian, Yi-Jun Gu, Department of Ultrasound, Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University, Shanghai 200433, China
Jiao Yu, Department of Infectious Diseases, Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University, Shanghai 200433, China
Yu-Qing Zhou, Hui-Ping Zhang, Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, Shanghai 200050, China
Author contributions: Guo J and Jiang D contributed equally to this work; Guo J, Jiang D, Yu J and Zhang HP designed the study; Guo J, Jiang D, Qian Y and Gu YJ performed the research and collected data; Zhang HP and Zhou YQ performed statistical analysis; Guo J and Jiang D wrote the manuscript; all authors have read and approved the final manuscript.
Supported by Natural Science Foundation of Shanghai of China, No. 19ZR1441500, No. 22ZR1458200; Science Research Foundation of Shanghai Municipal Health Commission, No. 202140378; and Key Program of Science and Technology Commission Foundation of Changning, Shanghai, China, No. CNKW2020Z04.
Institutional review board statement: The study was approved by the Institutional Ethical Review Board of Eastern Hepatobiliary Surgery Hospital Affiliated to Naval Medical University (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: All patients provided written informed consent prior to study enrollment before ultrasound examinations.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
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: Hui-Ping Zhang, MD, PhD, Associate Chief Physician, Department of Ultrasound, Shanghai Changning Maternity and Infant Health Hospital, East China Normal University, No. 786 Yuyuan Road, Shanghai 200050, China. zhanggirldan@163.com
Received: April 6, 2022
Peer-review started: April 6, 2022
First decision: June 27, 2022
Revised: July 15, 2022
Accepted: July 31, 2022
Article in press: July 31, 2022
Published online: August 28, 2022
Processing time: 141 Days and 21.9 Hours
Abstract
BACKGROUND

The clinical management and prognosis differ between benign and malignant solid focal liver lesions (FLLs), as well as among different pathological types of malignant FLLs. Accurate diagnosis of the possible types of solid FLLs is important. Our previous study confirmed the value of shear wave elastography (SWE) using maximal elasticity (Emax) as the parameter in the differential diagnosis between benign and malignant FLLs. However, the value of SWE in the differential diagnosis among different pathological types of malignant FLLs has not been proved.

AIM

To explore the value of two-dimensional SWE (2D-SWE) using Emax in the differential diagnosis of FLLs, especially among different pathological types of malignant FLLs.

METHODS

All the patients enrolled in this study were diagnosed as benign, malignant or undetermined FLLs by conventional ultrasound. Emax of FLLs and the periphery of FLLs was measured using 2D-SWE and compared between benign and malignant FLLs or among different pathological types of malignant FLLs.

RESULTS

The study included 32 benign FLLs in 31 patients and 100 malignant FLLs in 96 patients, including 16 cholangiocellular carcinomas (CCCs), 72 hepatocellular carcinomas (HCCs) and 12 liver metastases. Thirty-five FLLs were diagnosed as undetermined by conventional ultrasound. There were significant differences between Emax of malignant (2.21 ± 0.57 m/s) and benign (1.59 ± 0.37 m/s) FLLs (P = 0.000), and between Emax of the periphery of malignant (1.52 ± 0.39 m/s) and benign (1.36 ± 0.44 m/s) FLLs (P = 0.040). Emax of liver metastases (2.73 ± 0.99 m/s) was significantly higher than that of CCCs (2.14 ± 0.34 m/s) and HCCs (2.14 ± 0.46 m/s) (P = 0.002). The sensitivity, specificity and accuracy were 71.00%, 84.38% and 74.24% respectively, using Emax > 1.905 m/s (AUC 0.843) to diagnose as malignant and 23 of 35 (65.74%) FLLs with undetermined diagnosis by conventional ultrasound were diagnosed correctly.

CONCLUSION

Malignant FLLs were stiffer than benign ones and liver metastases were stiffer than primary liver carcinomas. 2D-SWE with Emax was a useful complement to conventional ultrasound for the differential diagnosis of FLLs.

Keywords: Focal liver lesions; Conventional ultrasound; Two-dimensional shear wave elastography; Differential diagnosis

Core Tip: Two-dimensional shear wave elastography (2D-SWE) could address the limitations of point SWE and provide overall elastic information in tumors and locate the stiffest part of the tumors. We used 2D-SWE with maximal elasticity to measure the stiffness of focal liver lesions (FLLs) and to explore the value of 2D-SWE in the differential diagnosis of FLLs, especially among different pathological types of malignant FLLs. Our results showed malignant FLLs were stiffer than benign ones and liver metastases were stiffer than primary liver carcinomas. 2D-SWE with Emax was useful complement to conventional ultrasound for the differential diagnosis of FLLs.