Application of contrast-enhanced ultrasound combined with serum alpha fetoprotein (AFP) and amyloid A/C-reactive protein (SAA/CRP) levels in the differential diagnosis of hepatocellular adenoma and carcinoma

Abstract

Abstract: Objective To evaluate the effectiveness of contrast-enhanced ultrasound (CEUS) combined with serum alpha fetoprotein (AFP) and serum amyloid A/C-reactive protein (SAA/CRP) levels in distinguishing between hepatocellular adenoma (HCA) and hepatocellular carcinoma (HCC). Methods A retrospective analysis was conducted on 119 patients treated in Qinhuangdao Traditional Chinese Medicine Hospital from March 2020 to June 2023. Among them, 60 were HCC patients,(28 with high differentiation and 32 with low differentiation), and 29 were HCA patients. Among them, 10 were HNF1a mutant (H-HCA) patients, 10 were β- Catenin mutant with HCA, and 9 were inflammatory HCA type (IHCA). We compared the CEUS parameters (starting time, starting intensity, peak time, and peak intensity) of all patients underwent CEUS examination. Serum AFP, SAA, and CRP levels were measured using enzyme-linked immunosorbent assay (ELISA). The receiver operating characteristic (ROC) curves and COX multivariate analysis were performed to evaluate the combination of CEUS, AFP, and SAA/CRP levels in diagnosing HCA and HCC. Results CEUS parameters (onset time, peak time, and peak intensity) in HCC group were lower than that in HCA group (P<0.05), and SAA/CRP levels could distinguish between HCA and HCC; The level of biomarkers can reflect the differentiation degree of HCC, showing high sensitivity and specificity; The combination of CEUS with AFP and SAA/CRP levels showed the highest diagnostic efficacy in the detection of HCA and HCC, with an area under the curve of 0.953, sensitivity of 93.1%, specificity of 90.0%, and a Yoden index of 0.831, which achieved better diagnostic efficacy than using a single indicator; Multivariate COX analysis showed that the onset time, onset intensity, peak time and intensity, AFP and SAA/CRP levels were all factors affecting the diagnosis of HCA and HCC (P<0.05). Conclusion CEUS combined with the serum AFP and SAA/CRP provides a higher accurate method for the differential diagnosis of HCA and HCC. The high sensitivity and specificity of this combination method may have a significant impact on clinical decision-making and patient treatment choice.

Key words: Contrast-enhanced ultrasound, Serum alpha fetoprotein, Serum amyloid A/C reactive protein, Liver adenoma, Hepatocellular carcinoma, Diagnostic value

WANG Qian, LIANG Shuang, LI Jing, XU Jia-qi, WANG Fang-xu. Application of contrast-enhanced ultrasound combined with serum alpha fetoprotein (AFP) and amyloid A/C-reactive protein (SAA/CRP) levels in the differential diagnosis of hepatocellular adenoma and carcinoma[J]. Chinese Hepatolgy, 2025, 30(2): 211-215.

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