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Contrast-Enhanced Ultrasound Algorithms (CEUS-LIRADS/ESCULAP) for the Noninvasive Diagnosis of Hepatocellular Carcinoma – A Prospective Multicenter DEGUM Study

2020; Georg Thieme Verlag; Volume: 42; Issue: 02 Linguagem: Inglês

10.1055/a-1198-4874

1438-8782

Barbara Schellhaas, T. Bernatik, W Bohle, Fanny Borowitzka, Johannes Chang, Christoph F. Dietrich, Klaus Dirks, R Donoval, Kristine Drube, Mireen Friedrich‐Rust, Christine M. Gall, Fleur Gittinger, Martin Gutermann, Mark Martin Haenle, Alexandra von Herbay, Chau Hong Ho, Rico Hochdoerffer, Tatjana Hoffmann, Matthias Hüttig, Christopher M. Janson, Ernst‐Michael Jung, N K Jung, Thomas Karlas, Christoph Klinger, Adam Kornmehl, Wolfgang Kratzer, Sebastian Krug, Georg Kunze, J Leitlein, Alexander Link, Christian Lottspeich, Aldo Marano, Martin Mauch, L Moleda, Albrecht Neeße, Golo Petzold, Andrej Potthoff, Michael Praktiknjo, Klaus-Dieter Rösner, Stefan Schanz, Michael Schultheiß, Visvakanth Sivanathan, Joachim Stock, Thomas Thomsen, Johanna Vogelpohl, Christoph Vogt, Siegfried Wagner, Christiane Wiegard, Isabel Wiesinger, Uwe Will, Matthias Ziesch, Patrick Zimmermann, Deike Strobel,

Liver Disease and Transplantation

Abstract Background This prospective multicenter study funded by the DEGUM assesses the diagnostic accuracy of standardized contrast-enhanced ultrasound (CEUS) for the noninvasive diagnosis of hepatocellular carcinoma (HCC) in high-risk patients. Methods Patients at high risk for HCC with a histologically proven focal liver lesion on B-mode ultrasound were recruited prospectively in a multicenter approach. Clinical and imaging data were entered via online entry forms. The diagnostic accuracies for the noninvasive diagnosis of HCC were compared for the conventional interpretation of standardized CEUS at the time of the examination (= CEUS on-site) and the two CEUS algorithms ESCULAP (Erlanger Synopsis for Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at risk) and CEUS LI-RADS (Contrast-Enhanced UltraSound Liver Imaging Reporting and Data System). Results 321 patients were recruited in 43 centers; 299 (93.1 %) had liver cirrhosis. The diagnosis according to histology was HCC in 256 cases, and intrahepatic cholangiocarcinoma (iCCA) in 23 cases. In the subgroup of cirrhotic patients (n = 299), the highest sensitivity for the diagnosis of HCC was achieved with the CEUS algorithm ESCULAP (94.2 %) and CEUS on-site (90.9 %). The lowest sensitivity was reached with the CEUS LI-RADS algorithm (64 %; p < 0.001). However, the specificity of CEUS LI-RADS (78.9 %) was superior to that of ESCULAP (50.9 %) and CEUS on-site (64.9 %; p < 0.001). At the same time, the negative predictive value (NPV) of CEUS LI-RADS was significantly inferior to that of ESCULAP (34.1 % vs. 67.4 %; p < 0.001) and CEUS on-site (62.7 %; p < 0.001). The positive predictive values of all modalities were high (around 90 %), with the best results seen for CEUS LI-RADS and CEUS on-site. Conclusion This is the first multicenter, prospective comparison of standardized CEUS and the recently developed CEUS-based algorithms in histologically proven liver lesions in cirrhotic patients. Our results reaffirm the excellent diagnostic accuracy of CEUS for the noninvasive diagnosis of HCC in high-risk patients. However, on-site diagnosis by an experienced examiner achieves an almost equal diagnostic accuracy compared to CEUS-based diagnostic algorithms.