Contrast-enhanced ultrasound predicts risk of progression to HCC

Contrast-enhanced ultrasound (CEUS) exams can reveal biomarkers that predict if cirrhotic nodules will become malignant in patients at risk for hepatocellular carcinoma (HCC).

“Approximately 80% of HCCs develop in patients with underlying chronic hepatitis or cirrhosis,” Manxia Lin of China’s Sun Yat-Sen University and colleagues wrote. “In these patients, most HCCs show multistep hepatocarcinogenesis in which regenerative nodules (RNs) can progress to dysplastic nodules (DNs) and later evolve into early HCC.”

Additionally, the group noted, current methods that help predict progression to HCC—including histologic and CT-based variables—require biopsy, which isn’t typically performed in cirrhosis cases. To date, only one biomarker—which is controversial—has been found to predict a potential change to malignancy.

Lin and colleagues analyzed 39 consecutive patients with 44 pathologically confirmed cirrhotic nodules who first received a CEUS exam, followed by a traditional follow-up ultrasound every three or four months.

Overall, the group reported that 14 of the 44 nodules (31.8%) transformed to malignancy after a median follow-up period of 26.7 months. This was largely revealed because the contrast arrival time difference between the cirrhotic nodule and the liver helped them stratify the risk of future malignancy, Lin et al. wrote.

The researchers also pointed out that the “relative growth rate” of 30% or more in six months, or an absolute growth rate of 5 millimeters or more in that time frame “highly indicated malignant transformation.”

More research will be needed to confirm the biomarkers, Lin and co-authors acknowledged, but their findings bode well for patients.

“Knowledge of malignant transformation risk is important in clinical management, including customization of surveillance strategy, decision to biopsy, or offering treatment earlier versus later,” the team concluded.

The full study was published Oct. 23 in the American Journal of Roentgenology.