| Objective:The aim of the study was to preoperatively investigate the diagnostic performance of two-dimensional shear wave elastography(2D-SWE)for staging liver fibrosis and inflammation in patients with hepatocellular carcinoma(HCC)who underwent surgery and to determine the ideal location for measurement.Methods:This study enrolled 106 patients with HCC who were admitted to the department of hepatobiliary surgery at the first affiliated hospital of medical college of zhejiang university from March 2018 to June 2019 and received surgical treatment.To collected data including the general conditions,etiology,medical history,previous history and status of basic diseases.Liver stiffness measurement(LSM)using 2D-SWE was performed in the liver parenchyma at 0–1 cm,1–2 cm and 2-5 cm from the tumor edge(group 1,group 2 and group 3,respectively)for each patient preoperatively.According to the measurement location of the area of interest(ROI),they were divided into three groups,namely group 1: 0-1cm from the tumor edge;Group 2: 1-2cm from the tumor edge;Group 3: 2-5cm from tumor edge.Five measurements were obtained for each location according to the latest European Federation of Societies for Ultrasound in Medicine and Biology(EFSUMB)guidelines and liver stiffness values were measured in three different areas for each patient.Fibrosis and inflammatory activity diagnoses were confirmed by pathology after surgery utilizing the METAVIR system as the standard.Based on this system,liver fibrosis was staged in F0-F4 and liver inflammation in A0-A3.In particular,histopathologic surgical specimens were obtained at 0-1 cm,1-2 cm and 2-5 cm from the tumour border for analysis.All specimens were underwent hematoxylineosin(HE)and Masson's trichrome staining.According to different histological grades,univariate and multivariate binary logistic regression was used to analyze the relationship between liver fibrosis,inflammation and liver hardness.Receiver operating characteristic(ROC)curve analysis was carried out to estimate the diagnostic performance of 2D-SWE in different regions.Results: 1.This study enrolled 106 HCC patients.The median age of the patients was 55 y(range:29-76 y);84 patients(79.2%)were male,and 89(84.0%)had chronical hepatitis B.The median tumour size was 5.6 cm(range: 2.1-9.3 cm).The clinical history was as follows: 27 patients(25.5%)had hypertension,16(15.1%)had type 2 diabetes,and 23(21.7%)had hyperlipidaemia.2.Group 1 and group 2 measurements were successful in 63 patients(63/106,59.4%),and group 3 measurements were successful in 91 patients(91/106,85.8%).The technical success rate for group 1 and group 2 was lower than that for group 3(P<0.001).3.The LSM values for group 1(17.9 k Pa)were obviously higher than those for group 2(14.9k Pa)and also higher than those for group 3(10.0k Pa)(P<0.001 or P=0.003) Comparing hepatic stiffness across stages of fibrosis for group 3,the median LSM values in stage F4 were clearly higher than those in stage F3(P=0.012)and stage F2(P<0.001);the LSM values in stage F3 were also higher than those in stage F2(P=0.034).These findings were also observed for groups 1 and 2.Furthermore,Spearman correlation analysis showed that liver stiffness values had a moderate to a strong relationship with fibrosis stage in all groups(r>0.5 and P< 0.001).Interestingly,the correlation in group 3(r= 0.849,P<0.001)was stronger than that in groups 2(r=0.623,P<0.001)and 1(r= 0.541,P<0.001).4.By comparing the stiffness value and inflammatory activity stage for group 3,we found that LSM values in stage A3 and stage A2 were higher than those in stage A1(P<0.001),though there was no difference between stage A3 and stage A2(P>0.05).These results were also observed for group 2.To our surprise,no clear difference between different stages was found for group 1(P>0.05).Additionally,according to Spearman correlation analysis,LSM values had a moderate association with inflammatory activity stage in group 3(r=0.597,P<0.001).5.Based on ROC curves for group 1,group 2 and group 3 to distinguish significant fibrosis(stage ?F2),area under the receiver operating characteristic curve(AUROCs) of 0.702,0.728 and 0.914 with ideal cut-offs of 16.6 k Pa,13.1 k Pa and 8.4 k Pa,respectively,were obtained.The ROC curves for group 1,group 2 and group 3 to distinguish liver cirrhosis(stage F4)indicated AUROCs of 0.800,0.842 and 0.948,with ideal cut-offs of 23.2 k Pa,14.6 k Pa and 11.2 k Pa,respectively.Comparing the three groups,group 3 showed a higher diagnostic accuracy for stage ?F2 and stage F4 than did group 1(p=0.012 and p=0.012)or group 2(p=0.046 and p=0.048).6.The AUROC values of group 1,group 2 and group 3 for differentiating stage ?A2 were 0.591,0.592 and 0.828,with ideal cut-offs of 15.8 k Pa,11.4 k Pa and 11.2 k Pa,respectively.The ROC curves for distinguishing stage A3 generated AUROCs of 0.615,0.773 and 0.810,with ideal cut-offs of 24.1 k Pa,17.9 k Pa and 11.6 k Pa,for group 1,group 2 and group 3,respectively.Thus,group 3 had a better diagnostic performance for diagnosing stage ?A2 and stage A3(both AUROC >0.800).Unexpectedly,group 3 had a preferable diagnostic accuracy for stage A3 compared to group 1(P=0.039)but not group 2(P> 0.05).Conclusions: 1.Our findings confirmed that 2D-SWE is a valuable,accurate and non-invasive approach to preoperatively assess liver fibrosis and inflammation activity in patients with liver tumours.2.We identified that LSM should be performed 2-5 cm from the tumor edge in HCC patients to achieve a superior success rate,a stronger correlation between liver stiffness and fibrosis,and better diagnostic accuracy.3.2D-SWE can not only assess liver fibrosis,but also help assess hepatitis activity.The dual characteristics of LSM may be helpful to clinicians in the management of HCC patients and patients with chronic liver disease.4.Further multicenter clinical studies and use of animal models are warranted to verify these findings.Clinicians should pay attention to the evaluation of liver fibrosis and inflammation activity before operation in patients with liver cancer. |
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