Published online Jun 7, 2022. doi: 10.3748/wjg.v28.i21.2350
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
Contrast-enhanced ultrasound (CEUS) has recently been approved to be used in characterization of 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. However, it is not suitable for pediatric patients.
To explore a method for differentiating benign and malignant FLLs in pediatric patients.
To evaluate the performance of CEUS LI-RADS combined with alpha-fetoprotein (AFP) in differentiating benign and malignant FLLs in pediatric patients.
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.
There were no statistically significant differences between the specificity, accuracy, or AUC of criterion II and criterion III. Notably, criterion III showed a higher diagnostic sensitivity than criterion II. However, both the specificity and accuracy of criterion I was inferior to those of criterion II and criterion III. 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.
We propose a novel method that might be a powerful diagnostic tool to differentiate malignant from benign FLLs in pediatric patients. LR-4 with elevated AFP, LR-5 or LR-M lesions could effectively differentiate benign and malignant tumors in pediatric patients.
CEUS LI-RADS combined with AFP might be a powerful diagnostic tool to differentiate malignant from benign FLLs in pediatric patients.