Jiang ZP, Zeng KY, Huang JY, Yang J, Yang R, Li JW, Qiu TT, Luo Y, Lu Q. Differentiating malignant and benign focal liver lesions in children using CEUS LI-RADS combined with serum alpha-fetoprotein. World J Gastroenterol 2022; 28(21): 2350-2360 [PMID: 35800178 DOI: 10.3748/wjg.v28.i21.2350]
Corresponding Author of This Article
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
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Retrospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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: http://creativecommons.org/licenses/by-nc/4.0/
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 bythe 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
ARTICLE HIGHLIGHTS
Research background
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.
Research motivation
To explore a method for differentiating benign and malignant FLLs in pediatric patients.
Research objectives
To evaluate the performance of CEUS LI-RADS combined with alpha-fetoprotein (AFP) in differentiating benign and malignant FLLs in pediatric patients.
Research methods
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.
Research results
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.
Research conclusions
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.
Research perspectives
CEUS LI-RADS combined with AFP might be a powerful diagnostic tool to differentiate malignant from benign FLLs in pediatric patients.
