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Efficacy Evaluation on the Color Doppler Ultrasound, Multislice Spiral CT Combined with Serum Markers in Diagnosis of Primary Hepatic Carcinoma

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Efficacy Evaluation on the Color Doppler Ultrasound, Multislice Spiral CT Combined with Serum Markers in Diagnosis of Primary Hepatic Carcinoma Iran J Public Health, Vol. 50, No.8, Aug 2021, pp.1603-1612 Original Article Efficacy Evaluation on the Color Doppler Ultrasound, Multislice Spiral CT Combined with Serum Markers in Diagnosis of Primary Hepatic Carcinoma Xiaolan Zhao 1, Yifang Xia 2, Chunjing Li 2, *Dapeng Wang 3 1. Department of Ultrasound, Yantaishan Hospital, Yantai 264000, China 2. Department of Imaging, Zhangqiu District People’s Hospital, Jinan 250200, China 3. Department of Imaging, the Affiliated Hospital of China University of Petroleum (East China), Qingdao 266580, China *Corresponding Author: Email: [email protected] (Received 22 Nov 2020; accepted 09 Dec 2020) Abstract Background: The efficacy of color Doppler ultrasound, multislice spiral CT combined with serum alpha- fetoprotein (AFP) and alpha-fetoprotein heterogeneity (AFP-L3) in the diagnosis of primary hepatic carcino- ma was evaluated. Methods: Seventy-nine patients with primary hepatic carcinoma (PHC group) and 50 patients with benign liver lesions (benign control group) admitted in Yantaishan Hospital (Yantai, China) from January 2016 to December 2018 were selected. The liver was scanned by color Doppler ultrasound and multiple multislice spi- ral CT. The serum AFP and AFP-L3 levels were detected by electrochemiluminescence. The value of color Doppler ultrasound, multislice spiral CT combined with serum AFP and AFP-L3 in diagnosis of primary liver cancer was retrospectively analyzed. Results: The color Doppler flow imaging (CDFI) showed a high-speed and high-resistance spectrum. The serum AFP and AFP-L3 levels of patients with primary hepatic carcinoma were significantly higher than those of the benign control group were (U=138.000 and 155.500, P=0.000 and 0.000), P<0.01. The sensitivity, accu- racy and negative predictive value of color Doppler ultrasound, multislice spiral CT combined with serum AFP and AFP-L3 examinations for diagnosis of primary hepatic carcinoma were 96.20, 90.70 and 93.18%, which was significantly improved compared with each single examination (X2=27.888, 17.511 and 16.202, P=0.000, 0.002 and 0.003), P<0.01. Conclusion: Color Doppler ultrasound, multislice spiral CT combined with AFP and AFP-L3 examination could significantly improve the diagnosis efficiency of primary hepatic carcinoma, which was beneficial to early clinical diagnosis and early treatment. Keywords: Primary hepatic carcinoma; Ultrasound; Multislice Spiral CT; Alpha-fetoprotein receptor; Combi- nation examination Introduction Primary hepatic carcinoma (PHC) was one of the and the sixth most common cancer in the world most common malignant tumors in the world (1) nowadays (2), for which the mortality rate ranks Copyright © 2021 Zhao et al. Published by Tehran University of Medical Sciences. This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International license (https://creativecommons.org/licenses/by-nc/4.0/). Non-commercial uses of the work are permitted, provided the original work is properly cited. 1603 Available at: http://ijph.tums.ac.ir Zhao et al.: Efficacy Evaluation on the Color Doppler Ultrasound, Multislice … as the second in China (3). Among them, primary China）. PHC was diagnosed according to histo- hepatocellular carcinoma (HCC) was the main logical classification criteria from WHO (2005) pathological type of PHC (it was counting for liver and intrahepatic bile duct tumor (10). There approximately 75% -85%) (4). were 47 males and 32 females, 35-82 yr old, with In recent years, with the change of lifestyle and an average age of (55.23±8.96). The staging crite- the accelerating aging process, the morbidity and ria was in accordance with Union for Interna- mortality of PHC have been increasing year by tional Cancer Control and American Joint Com- year-worldwide (5). The pathogenesis of primary mittee on Cancer (UICC/AJCC, 2010), and there hepatic carcinoma is relatively insidious, and were 11 cases in stage I, 27 cases in stage II, 31 most patients are diagnosed in the middle or ad- cases in stage III, and 10 cases in stage VI. vanced stages, therefore, they lost the best oppor- tunities for radical treatments. Based on the sta- Benign liver disease group tistics, the five-year survival rate of advanced liver There were 29 males and 21 females, 33-81 yr old cancer was less than 10% (6). Thus, early treat- with an average age of (56.72±7.98) yr, including ment was the key to affecting the prognosis of 20 cases with liver cirrhosis, 10 cases with hepatic primary hepatic carcinoma (7). hemangioma, 15 cases with hepatic cysts, 5 cases The diagnosis of primary hepatic carcinoma rare- with hepatocellular adenoma. ly depends on pathological needle biopsy, there- The inclusion criteria of PHC group: ① They fore, the non-invasive diagnostic methods play a were diagnosed by puncture biopsy or surgical crucial role in the early diagnosis (8). Imaging ex- pathological examination, all of them had com- amination (including ultrasound and CT) is a plete examination data of liver color Doppler ul- common method for diagnosis of primary hepat- trasound, multislice spiral CT, and serum AFP ic carcinoma, which could display the liver mor- and AFP-L3; ② patients who were newly diag- phology, lesion size and specific anatomical loca- nosed without receiving tumor-related treatment tion of patient effectively. However, it is easy to before. ③ patients who signed the consent and misdiagnosis for small liver cancer (for those di- cooperated in this study. ameter<3 cm). At present, AFP is the most wide- Exclusion criteria: ① patients who had other ly used as clinical diagnostic marker of PHC se- malignant tumors were excluded. ② patients rum, but it could not ensure the high sensitivity and strong specificity, with some certain limita- who had incomplete study data. ③ patients who tions (9), indicating that any singular examination did not cooperate with researcher. method has limited application value. This study was approved by the hospital Ethics We aimed to choose color Doppler ultrasound, Committee, and the study subjects had signed an multislice spiral CT combined with serum AFP informed consent form. and AFP-L3 to diagnose primary hepatic carci- noma, which intended to provide a reference for Test the early diagnosis of primary hepatic carcinoma. Color Doppler ultrasound examination The diagnostic instrument was PHILIPS iU22, Methods with the probe frequency of 3.5-5.0 MHz. The patient fasted for over 8 hours. In the examina- tion, the lateral or supine position was taken, and Clinical materials the liver was scanned carefully to observe the lo- Seventy-eight patients with primary hepatic carci- cation, number, size, shape, echo, intrahepatic noma (PHC group) and 50 patients with benign bile duct, lumen of the lesion. Afterwards, the liver lesions (benign control group) were selected blood flow in the lesion area was measured by as the study subjects from January 2016 to De- color Doppler ultrasound mode, and the peak cember 2018 in Yantaishan Hospital （ Yantai, systolic velocity (Vmax) and resistance index (RI) Available at: http://ijph.tums.ac.ir 1604 Iran J Public Health, Vol. 50, No.8, Aug 2021, pp.1603-1612 of each lesion were measured. The blood flow AFP-L3 affinity adsorption centrifuge tube, the signal was divided into four levels: Grade 0 was required eluent were provided by Beijing Hotgen defined as no blood supply in the tumor; Grade I Biotech Co., Ltd. AFP-L3 was separated by a mi- was that there was blood supply with less amount cro centrifugal column method. Agarose coupled in the tumor, with 1 to 2 punctiform blood flow; with LCA was used as the affinity medium in the Grade II was that there was rich blood flow in centrifugal column, which could specifically bind the tumor, with 3 to 4 punctiform blood flow to AFP-L3. Overall, 400 ul serum of the research generally or 1 to 2 blood vessels; Grade III was subject was add into 600 ul of cleaning solution that there was abundant blood flow in the tumor, and mixed, for which the 600 ul of the diluted with over 4 punctiform blood flow or more than serum dilution was taken into the agarose spin 2 blood vessels. column coupled with LCA. The strong AFP het- erogeneity bonded with LCA was left in the spin Multislice spiral CT examination column, and the unbound AFP was washed away The instrument was SIEMENS SOMATOM with the cleaning solution. After finally eluting Definition flash spiral CT machine. The scanning with the special eluent, the processed sample was parameters were as follows: tube voltage and cur- obtained, which contained the relative pure AFP- rent were 120 KV and 160 mA/s, screw pitch L3. was 1.5 and layer thickness was 10 mm. During Determination of AFP and AFP-L3 method was the examination, the patients were asked to take electrochemiluminescence immunoassay, with the the supine position, and the scan ranged from the principle as the double antibody sandwich princi- diaphragm to the lower edge of the pubic sym- ple. The instrument ELecsys-2010 was provided physis was performed. At first, the conventional by German Roche Company, and AFP and AFP- CT scan was performed. Afterwards, the L3 diagnostic reagents were provided by Roche nonionic iodine-containing contrast agent iohexol Diagnostics, to determine the original serum AFP was intravenous injected by a high-pressure sy- and purified AFP-L3 levels. The operations were ringe through the cubital vein of patients (Yangze in strictly accordance with the operation manual. River Pharmaceutical Group Co., Ltd., National Drug Permission NO.H10970322) in the dosage Result determination of 1.0 ml·kg-1, with the injection speed as 3.0～ CT, ultrasound and pathological diagnosis of 4.0 mL/s, and the total hepatic three-phase dy- PHC group and benign control group in con- namic enhancement scan in arterial-phases, portal formity were defined as true positive or true neg- vein phase and the hepatic artery phase were re- ative, and non-conformity was defined as false spectively performed at 20～25 s, 50～60 s and positive or false negative.
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