Abstract: Objective To investigate diagnostic value of contrast-enhanced ultrasound (CEUS) characteristics and changes in serum alpha-fetoprotein (AFP), carbohydrate antigen 199 (CA199), carbohydrate antigen 125 (CA125) in patients with early primary liver cancer (HCC). Methods Using pathological results as the gold standard for diagnosis, 80 patients with early HCC diagnosed in Nanjing Gaochun People's Hospital from August 2018 to August 2021 were selected as the HCC group, while 80 patients with liver benign nodules were selected as the benign group. The characteristic parameters of CEUS in the two groups were compared and analyzed. Serum levels of AFP, CA199 and CA125 in the HCC and benign group were measured and analyzed by statistical hypothesis testing. 2×2 four-grid tables were conducted based on the gold standard diagnosis results to evaluate the accuracy of different diagnosic methods when use alone and in combination for distinguishing between benign and malignant liver tumors. Results In the HCC group, 87.50% of cases had single lesions, 30.00% had unclear boundary features, 26.25% had irregular lesions, and 26.25% had rich blood supply. Additionally, 80.00% exhibited equal or low enhancement in the CEUS portal phase, and 86.25% displayed equal or low enhancement in the CEUS delay phase, all of which were significantly higher than those in the benign group. These parameters demonstrated significant differences between the HCC group and the benign group (P<0.05). Furthermore, laboratory examination revealed significantly higher levels of AFP (25.91 ± 8.44) μg/L, CA199 (41.46 ± 10.20) U/mL, and CA125 (39.20 ± 11.32) U/mL in the HCC group compared to the benign group (P<0.05), where the levels of AFP, CA199, and CA125 were (16.42 ± 6.73) μg/L, (28.74±8.62) U/mL, and (27.13±7.57) U/mL, respectively. The combination of CEUS, AFP, CA125, and CA199 demonstrated a sensitivity of 95.00%, specificity of 82.50%, missed diagnosis rate of 5.00%, misdiagnosis rate of 17.50%, positive predictive value of 84.44% and negative predictive value of 94.29% in the diagnosis of HCC and benign liver tumors. Conclusion The combined use of CEUS, AFP, CA125, and CA199 in the diagnosis of early HCC and benign liver tumors has been shown to significantly enhance diagnostic sensitivity and ensure superior diagnostic specificity compared to the application of each index individually.

Key words: Contrast-enhanced ultrasound, Alpha-fetoprotein, Carbohydrate antigen 199, Carbohydrate antigen 125, Diagnosis, Hepatocellular carcinoma