Diagnostic Value of Imaging Methods in the Histological Four Grading of Hepatocellular Carcinoma

Abstract

We attempted to establish an ultrasound (US) imaging-diagnostic system for histopathological grades of differentiation of hepatocellular carcinoma (HCC). We conducted a retrospective study of histopathologically confirmed 200 HCCs, classified as early (45 lesions), well- (31 lesions), moderately (68 lesions) or poorly differentiated (diff.) (56 lesions) HCCs. We performed grayscale US to estimate the presence/absence of halo and mosaic signs, Sonazoid contrast-enhanced US (CEUS) to determine vascularity (hypo/iso/hyper) of lesion in arterial and portal phase (PP), and echogenicity of lesion in post-vascular phase (PVP). All findings were of significance for the diagnosis of some (but not all) histological grades (p < 0.001–0.05). Combined findings with a relatively high diagnostic efficacy for early, poorly and moderately diff. HCC were a combination of absence of halo sign and isoechogenicity in PVP of CEUS (accuracy: 93.0%, AUC: 0.908), hypovascularity in PP (accuracy: 78.0%, area under the curve (AUC): 0.750), and a combination of isovascularity in PP and hypoechogenicity in PVP (accuracy: 75.0%, AUC: 0.739), respectively. On the other hand, neither any individual finding nor any combination of findings yielded an AUC of over 0.657 for the diagnosis of well-diff. HCC. Our study provides encouraging data on Sonazoid CEUS in the histological differential diagnosis of HCC, especially in early HCC, and the effectiveness of this imaging method should be further proved by prospective, large sample, multicenter studies.

Usefulness of Modified CEUS LI-RADS for the Diagnosis of Hepatocellular Carcinoma Using Sonazoid

“…These nodules were therefore classified as LR-M. Moreover, four (66.7%) of these nodules were poorly differentiated tumors, which is in line with the findings of previous studies [ 12 , 13 ]. However, this finding is actually rather advantageous, because poorly differentiated HCCs have higher malignant potential than other types of HCCs and are therefore more similar in nature to metastases [ 14 ].…”

Intraprocedurally EOB-MRI/US fusion imaging focusing on hepatobiliary phase findings can help to reduce the recurrence of hepatocellular carcinoma after radiofrequency ablation

“…The diagnosis of HCC were obtained by biopsy specimen, and was based on the criteria of the International Working Party [22] and International Consensus Group for Hepatocellular Neoplasia (ICGHN) [23]. The histological grade classification was made according to the research of Wang et al [24]. For the patients who participated in this study, the choice of method to guide RFA treatment was left to the senior hepatologists (K.N., K.O.…”

Use of Contrast-Enhanced Ultrasound with Sonazoid for Evaluating the Radiotherapy Efficacy for Hepatocellular Carcinoma

“…Sonazoid has been successfully investigated in many studies, showing high diagnostic accuracy, treatment response assessment, and guidance for HCC [ 33 , 34 , 35 , 36 ]. Furthermore, it has been recommended in Japanese guidelines for diagnosing HCC [ 37 ].…”