A nomogram based on clinical, ultrasound and contrast-enhanced ultrasound features for preoperative differentiating intrahepatic cholangiocarcinoma from hepatocellular carcinoma
10.3760/cma.j.cn131148-20240131-00078
- VernacularTitle:基于临床、常规超声及超声造影的列线图术前鉴别肝细胞癌和肝内胆管癌
- Author:
Chunrui LIU
1
;
Haiyan XUE
;
Han LIU
;
Peng WAN
;
Wentao KONG
;
Zhengyang ZHOU
;
Jing YAO
Author Information
1. 南京大学医学院附属鼓楼医院超声医学科，南京 210008
- Keywords:
Contrast-enhanced ultrasound;
Ultrasonography;
Intrahepatic cholangiocarcinoma;
Hepatocellular carcinoma;
Nomogram;
Differential diagnosis
- From:
Chinese Journal of Ultrasonography
2024;33(5):369-377
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To establish a nomogram for preoperative differentiating intrahepatic cholangiocarcinoma (ICC) from hepatocellular carcinoma (HCC) based on clinical, ultrasound, and contrast-enhanced ultrasound (CEUS) data.Methods:A retrospective analysis was conducted on ultrasound and CEUS data of 462 patients who underwent hepatectomy in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2016 to December 2023, including 262 cases of HCC (56.7%) and 200 cases of ICC (43.3%). The data were randomly divided into training set ( n=324) and validation set ( n=138) in a 7∶3 ratio. Univariate analysis was used to initially screen for variables with statistically significant differences between HCC and ICC groups in the training set, and LASSO regression was performed to select the variables with higher coefficients. Logistic regression analyses were then used to predict independent risk factors for ICC. A nomogram was drawn using R software. The performance of the nomogram was then validated using ROC curve, calibration curve, and decision curve analysis (DCA). Results:Univariate analysis showed that there were significant differences in age, gender, liver cirrhosis, HBsAg (+ ), ALP >185 U/L, CA19-9 >27 kU/L, CA242>10 kU/L, irregular shape, border, cholangiectasis, portal vein tumor thrombus, enhanced pattern in arterial phase, clearance time <60 s, intra-tumoral vein between ICC and HCC groups (all P<0.05). The top 10 features were selected for LASSO regression analysis. Logistic regression analysis revealed that gender, cirrhosis, CA19-9>27 kU/L, CA242>10 kU/L, cholangiectasis, clearance time <60 s, intra-tumoral vein and enhanced pattern in arterial phase were risk factors for ICC (all P<0.05). The area under the ROC curve in the training and validation groups were 0.963 and 0.914, respectively. In the training group, the specificity and sensitivity of the nomogram were 0.926 and 0.917, respectively, and in the validation group, they were 0.875 and 0.871, respectively. The calibration curve showed that the prediction effect of the model was in good agreement with the actual situation. DCA showed that the nomogram could increase the net benefit to the different diagnosis of ICC in patients. Conclusions:The nomogram based on clinical, ultrasound and CEUS features has a good predictive value for preoperative identification of ICC and provides reliable evidence for clinical practice.
