摘要
背景肝脏肿瘤性质的无创鉴别是当前临床面临的难题.超声造影(contrast-enhanced ultrasounds,CEUS)和血清甲胎蛋白(alpha-fetoprotein,AFP)/总胆汁酸(total bile acid,TBA)各具优势,但联合诊断价值尚不明确,本研究假设二者联合可提高肝脏肿瘤无创鉴别诊断效能,并与病理结果一致.目的研究CEUS联合血清AFP/TBA鉴别肝血管瘤、原发性肝癌及肝转移瘤与病理活检的一致性.方法选取2023-07/2025-03杭州市临安区第四人民医院收治的291例肝脏肿瘤患者作为研究对象,建立CEUS联合血清AFP/TBA的鉴别诊断模型,其中经组织病理确诊恶性198例(原发性肝癌135例,肝转移瘤63例)为恶性组,良性93例(肝血管瘤)为良性组.另选本中心2025-04/2025-06,124例肝脏肿瘤(组织病理学提示恶性88例,良性36例)患者作为外部验证数据.比较2组常规超声表现、CEUS结果及血清AFP/TB,构建Logistic回归模型分析恶性病变的影响因素,使用受试者工作特征(receiver operating characteristic,ROC)曲线分析CEUS、血清AFP/TBA单独及联合应用在病灶性质鉴别诊断中的价值,并采用ROC曲线、一致性分析对联合诊断效能进行内、外部评价.结果恶性组形态不规则占比、边界不清晰占比、内部回声不均匀占比、病灶及周围血流信号Ⅱ级+Ⅲ级占比、增强速率及血清AFP/TBA分别为32.83%、46.46%、60.10%、91.92%、(0.85±0.19)、(6.07±2.02),显著高于良性组20.43%、31.18%、24.73%、19.33%、(0.57±0.16)、(1.64±0.53),50%倾斜率、达峰时间分别为(0.59±0.12)、(35.40±7.62),显著低于良性组(0.80±0.24)、(44.93±10.51),差异均有统计学意义(P<0.05);Logistic回归模型分析显示,形态不规则、边界不清晰、内部回声不均匀、病灶及周围血流信号Ⅱ级+Ⅲ级、增强速率、血清AFP/TBA是恶性病变的危险因素,50%倾斜率、达峰时间是其保护因素(P<0.05);ROC曲线分析显示,CEUS联合血清AFP/TBA鉴别诊断病灶性质的曲线下面积为0.928,内、外部评价结果显示,净改善了86.50%的分类正确率及对病灶性质的区分能力(均P<0.001);一致性分析发现,CEUS与血清AFP/TBA鉴别诊断结果与病理活检结果一致性好(Kappa=0.819)(P<0.001).结论CEUS联合血清AFP/TBA对肝血管瘤、原发性肝癌及肝转移瘤具有一定鉴别诊断价值,且与病理活检结果具有良好一致性,可为临床无创鉴别诊断肝脏肿瘤性质提供参考,并可指导后续临床决策.
BACKGROUND The noninvasive differentiation of liver tumor nature remains a clinical challenge.While contrast-enhanced ultrasound(CEUS)and serum alpha-fetoprotein(AFP)/total bile acid(TBA)each have their advantages,the diagnostic value of their combined use remains unclear.This study hypothesized that combining these two modalities can improve the efficacy of noninvasive differential diagnosis of liver tumors while maintaining the consistency with pathological results.AIM To investigate the performance of CEUS combined with serum AFP/TBA in differentiating hepatic hemangioma,primary liver cancer,and liver metastases by using pathological biopsy as the golden standard.METHODS A total of 291 patients with liver tumors admitted to the Fourth People’s Hospital of Lin’an District from July 2023 to March 2025 were selected as the study subjects to establish a differen-tial diagnosis model combining CEUS with serum AFP/TBA.Among them,198 cases(135 cases of primary liver cancer and 63 cases of liver metastases)were histopathologically confirmed as malignant,forming a malignant group,while 93 cases(hepatic hemangioma)were benign,forming a benign group.Another 124 patients with liver tumors(88 malignant and 36 benign according to histopathology)from April 2025 to June 2025 in our center were selected for external validation.Conventional ultrasound findings,CEUS results,and serum AFP/TBA were compared between the two groups.A Logistic regression model was constructed to analyze the influencing factors of malignant lesions.Receiver operating characteristic(ROC)curve analysis was conducted to evaluate the value of CEUS and serum AFP/TBA alone and in combination for the differential diagnosis of lesion nature.Internal and external evaluation of diagnostic efficacy of the combination modality was conducted using ROC curves and consistency analysis.RESULTS In the malignant group,the proportions of tumors with an irregular morphology,unclear boundaries,uneven internal echoes,and surrounding blood flow signals of gradeⅡ+Ⅲ,as well as the enhancement rate and serum AFP/TBA levels,were 32.83%,46.46%,60.10%,91.92%,(0.85±0.19),and(6.07±2.02),respectively,which were significantly higher than those of the benign group[20.43%,31.18%,24.73%,19.33%,(0.57±0.16),and(1.64±0.53),P<0.05];and the 50%inclination rate and time to peak were(0.59±0.12)and(35.40±7.62),respectively,which were significantly lower than those of the benign group[(0.80±0.24)and(44.93±10.51),P<0.05].Logistic regression analysis showed that irregular morphology,unclear boundaries,uneven internal echoes,surrounding blood flow signals of gradeⅡ+Ⅲ,enhancement rate,and serum AFP/TBA were risk factors for malignant lesions,while 50%inclination rate and time to peak were protective factors(P<0.05).ROC curve analysis revealed that the area under the curve for CEUS combined with serum AFP/TBA in distinguishing lesion nature was 0.928.Internal and external evaluation results indicated a net improvement in classification accuracy and lesion property differentiation of 86.50%(P<0.001).Consistency analysis revealed good agreement between CEUS plus serum AFP/TBA diagnostic results and pathological biopsy results(Kappa=0.819)(P<0.001).CONCLUSION CEUS combined with serum AFP/TBA has appreciated diagnostic value in differentiating hepatic hemangioma,primary liver cancer,and liver metastases,and shows good consistency with pathological biopsy results.It can provide a reference for non-invasive clinical diagnosis of liver tumor nature and guide subsequent clinical decision-making.
作者
许建军
Jian-Jun Xu(Department of Special Inspection,Fourth People’s Hospital of Lin’an District,Hangzhou 311321,Zhejiang Province,China)
出处
《世界华人消化杂志》
2025年第8期657-665,共9页
World Chinese Journal of Digestology
关键词
超声造影
AFP/TBA
鉴别
肝血管瘤
原发性肝癌
肝转移瘤
病理
一致性
Contrast-enhanced ultrasound
AFP/TBA
Differentiation
Hepatic hemangioma
Primary liver cancer
Liver metastases
Pathology
Consistency
