The Preliminary Study Of Correlation In Real-time Tissue Elastography And Pathology Of Primary Hepatocellular Carcinoma

Background and ObjectivePrimary liver cancer is one of the most common malignancies. Primary liver cancerranks5th and second in incidence and mortality among malignancies in males worldwide,respectively; it ranks seventh and sixth in incidence and mortality worldwide amongmalignancies in females, respectively. Primary hepatocellular carcinoma (HCC) is themajor pathological type of the disease, accounting for70%-85%globally. HCC is aprevalent disesase in China where half of the cases and deaths occured. Currently, earlydiagnosis and treatment are mainly relied on to improve patient survival.Ultrasonography is one of the most commonly used methods to diagnose liverdisease. It is widely used in the diagnosis and differential diagnosis of various liverdiseases,including HCC because it is convenient, noninvasive, inexpensive, etc. Ultrasoundelastography is a new technology developed in recent years. It distinguishes betweenbenign and malignant diseases by the stiffness of the tissue in question. The technology isunique and the information it obtains is completely different from that obtained byconventional ultrasound and ultrasonic contrast methods. Real-time tissue elastography, asone type of ultrasound elastography, uses scoring method and SR value method to assessliver focal liver lesions and acquires the elasticity measurement of the lesion. Thistechnique is conducible to differential diagnosis of benign or malignant tumor. However,due to the particularity of focal liver lesions, the stiffness of the lesion may be affected bycertain pathological indices, such as the degree of differentiation, with or without a capsule,with or without intratumoral hemorrhage, with or without necrosis etc. in addition todifferences in lesion pathology. No related research in this fieid has been done for the timebeing.The research recruited HCC patients to perform real-time tissue elastography andobtained elasticity measurements. Correlation analysis was undertaken between elasticitydata and pathological indices. We preliminarily explored the correlation betweenpathological indices and real-time elastography measurements in HCC and their impactson the efficacy of differential diagnosis of benign focal lesions.Research Methods1．Case selection:The first part of the study analyzed73cases (65males/7females) who were pathologically confirmed to have HCC between August2011to August2013in ourhospital.The second part of the study analyzed73cases with pathological diagnosis of HCC and39cases with benign focal lesions (14cases of hepatic hemangioma,9cases of focalnodular hyperplasia,6cases of hepatic adenoma,7cases of angiomyolipoma,1case ofnecrotic nodules,1case of nodular sclerosis and1case of fatty infiltration) betweenAugust2011to October2013in our hospital. There were83males and29females in thissample.We have informed the patients and their families of the methods, purpose and possiblerisks in these studies before, and signed "informed consent".2. We intended to do a correlation analysis of real-time elastography measurements withpathological indices in HCC patientsReal-time elastography was performed on all73HCC cases and elasticity scores andSR values were obtained accordingly.Group comparision of the score and SR value withvariables like capsule, intratumoral hemorrhage, necrosis, microvascular cancer embolus,tissue type and paracancerous liver tissue types, respectively. The paracancerous livertissue type was set as the partial correlation factor with which Pearson partial correlationanalysis of each pathological index and the SR value was performed.3. We intended to perform real-time elastography to find out the impact of cirrhosis on thedifferential diagnosis of HCC and benign focal lesions.We divided aforementioned73HCC cases and39cases with benign focal legions intocirrhosis and non-cirrhotic group using real-time elastography, respectively. We used≥3points and SR value≥3.47as diagnostic criteria for carcinoma and the results of scoringmethod and SR value method were compared with pathological results respectively toanalyze the difference of diagnostic efficacy between two groups.Result1. It was shown in group comparisions of various pathological indices that the scoringmethod and SR values differed statistically (P<0.05) in different types of paracanceroustissue (liver cirrhosis and non-cirrhosis group). The paracancerous liver tissue type was setas the partial correlation factor and Pearson partial correlation analysis of each pathologicalindex with SR ratios was performed. The results showed that after adjustment of theparacancerous liver tissue type, SR values were negatively correlated with intratumoral hemorrhage, indicating a patient with intratumoral hemorrhage had lower SR values thanthose without intratumoral hemorrhage. No correlation was found between the rest of theindices and SR values.2. The results showed the diagnostic efficacy of both scoring method and SR value methoddisaccorded with pathological diagnosis in the whole sample and cirrhosis group(P＜0.05).But the diagnostic efficacy of both methods was in line with pathological diagnosis innon-cirrhotic group(Kappa values were0.5412and0.5698, respectively and all P valueswere0.0000). The percentage of consistency, sensitivity, specificity, the rate ofmisdiagnosis and missed diagnosis rate of scoring methods and SR value methods were77.27%and78.79%,76.32%and78.95%,78.57%and78.57%,21.43%and21.43%,23.68%and21.05%respectively in non-cirrhotic group. The diagnostic efficacy of thescoring method and SR value method was higher in non-cirrhotic group than that incirrhosis group.Conclusion:1．The stiffness measurement of HCC is correlated with liver cirrhosis and intratumoralhemorrhage.2．Differential diagnosis of HCC and benign lesions is affected by liver cirrhosis.