The gross classification of hepatocellular carcinoma: Usefulness of contrast‐enhanced US

Abstract

ABSTRACT Background This study investigated the usefulness of postvascular images of contrast‐enhanced ultrasonography (CE‐US) in the gross classification of hepatocellular carcinoma (HCC) in comparison with contrast‐enhanced CT (CE‐CT) findings. Methods This is a prospective study with consecutive HCC patients who had both CE‐US and CE‐CT prior to surgical resection. Fifty‐one patients (32 men, 19 women; mean age, 68.9 years) with 61 HCCs were enrolled. The maximal diameters of all tumors ranged from 1.0 to 5.0 cm (mean ± SD, 2.5 cm ± 1.1). Weighted kappa statistics were used to assess the agreement of the sonographic or CT findings versus the results of macroscopic configurations. Results Thirty‐nine tumors were macroscopically diagnosed as simple nodule type; 19 tumors were macroscopically diagnosed as simple nodular type with extranodular growth, and 3 were macroscopically diagnosed as confluent multinodular type from the resected specimen. The diagnostic accuracy was 86.9% (53/61) for CE‐US and 65.6% (40/61) for CE‐CT. The differences in accuracy between CE‐US and CE‐CT were statistically significant (McNemar; p = 0.007). Agreement analysis between gross classification using CE‐US and final macroscopic results gave a kappa value of 0.74 (95% CI: 0.65–0.82), which was considered a good agreement. On the other hand, kappa coefficient value was 0.38 (95% CI: 0.28–0.48) between gross classification using CE‐CT and final macroscopic results. Conclusions CE‐US is a more reliable tool than CE‐CT to evaluate the gross type of HCC than CE‐CT. Accurate gross classification using imaging is considered to be essential for the determination of the correct treatment strategy and the estimates of the patients' prognosis. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :1–8, 2014