Original Article

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


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 carcinoma 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 spiral 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, accuracy 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.

1. Colombo M (1992). Hepatocellular carcinoma. J Hepatol, 15(1-2): 225-236.
2. Bray F, Ferlay J, Soerjomataram I, et al (2018). Global Cancer Statistics 2018: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin, 68(6): 394-424.
3. El-Serag HB (2012). Epidemiology of viral hepatitis and hepatocellular carcinoma. Gastroenterology, 142(6): 1264-1273.
4. European Association for the Study of the Liver (2018). EASL Clinical Practice Guidelines: Man-agement of Hepatocellular Carcinoma. J Hepatol, 69(1): 182-236.
5. Torre LA, Bray F, Siegel RL, et al (2015). Global can-cer statistics, 2012. CA Cancer J Clin, 65(2): 87-108.
6. Trinchet JC, Alperovitch A, Bedossa P, et al (2009). Epidemiology, prevention, screening and diagno-sis of hepatocellular carcinoma. Bull Cancer, 96(1): 35-43.
7. Dong Y, Wang WP, Mao F, et al (2016). Application of imaging fusion combining contrast-enhanced ultrasound and magnetic resonanceimaging in de-tection of hepatic cellular carcinomas undetectable by conventional ultrasound. J Gastroenterol Hepatol, 31(4): 822-828.
8. van Meer S, de Man RA, Siersema PD, et al (2013). Surveillance for Hepatocellular Carcinoma in Chronic Liver Disease: Evidence and Controver-sies. World J Gastroenterol, 19(40): 6744-6756.
9. Chen GG, Ho RL, Wong J, et al (2007). Single nu-cleotide polymorphism in the promoter region of human alpha-fetoprotein (AFP) gene and its sig-nificance in hepatocellular carcinoma (HCC). Eur J Surg Oncol, 33(7): 882-826.
10. Bosman PI', Carneiro F, Hruban RH, et a1.WHO Classification of Tumours of the Digestive Sys-tem(4th)[M].Lyon, France: IACR Press, 2010, 425-440.
11. Shimazaki H (2016). Inspection of Hepatocellular Carcinoma 1: Ultrasonography. Nihon Hoshasen Gijutsu Gakkai Zasshi, 72(3): 281-289.
12. Kong S, Yue X, Kong S, et al (2018). Application of contrast-enhanced ultrasound and enhanced CT in diagnosis of liver cancer and evaluation of ra-diofrequency ablation. Oncol Lett, 16(2): 2434-2438.
13. Lin W, Zhao J, Cao Z, et al (2014). Livistona chinen-sis seeds inhibit hepatocellular carcinoma angio-genesis in vivovia suppression of the Notch pathway. Oncol Rep, 31(4): 1723-1728.
14. Zhan P, Qian Q, Yu LK (2013). Prognostic signifi-cance of vascular endothelial growth factor ex-pression inhepatocellular carcinoma tissue: a meta-analysis. Hepatobiliary Surg Nutr, 2(3): 148-155.
15. Lassau N, Chami L, Chebil M, et al (2011). Dynamic contrast-enhanced ultrasonography (DCE-US) and anti-angiogenic treatments. Discov Med, 11(56): 18-24.
16. Yang X, Zhu H, Hu Z (2010). Dendritic cells trans-duced with TEM8 recombinant adenovirus pre-ventshepatocellular carcinoma angiogenesis and inhibits cells growth. Vaccine, 28(43): 7130-7135.
17. Lee YJ, Lee JM, Lee JS, et al (2015). Hepatocellular carcinoma: diagnostic performance of multidetec-tor CT and MR imaging-a systematic review and meta-analysis. Radiology, 275(1): 97-109.
18. Hinrichs JB, Shin HO, Kaercher D, et al (2016). Par-ametric response mapping of contrast-enhanced biphasic CT for evaluating tumour viability of hepatocellular carcinoma after TACE. Eur Radiol, 26(10): 3447-3455.
19. Ladd LM, Tirkes T, Tann M, et al (2016). Compari-son of hepatic MDCT, MRI, and DSA to ex-plant pathology for the detection and treatment planning of hepatocellular carcinoma. Clin Mol Hepatol, 22(4): 450-457.
20. Oğul H, Kantarcı M, Genç B, et al (2014). Perfusion CT imaging of the liver: review of clinical applica-tions. Diagn Interv Radiol, 20(5): 379-389.
21. Dong A, Dong H, Zuo C, et al (2015). Diffuse In-fantile Hepatic Hemangioendothelioma With Ear-ly Central Enhancement in an Adult: A Case Re-port of CT and MRI Findings. Medicine (Baltimore), 94(51): e2353.
22. Lim TS, Kim DY, Han KH, et al (2016). Combined use of AFP, PIVKA-II, and AFP-L3 as tumor markers enhances diagnostic accuracy for hepato-cellular carcinoma in cirrhotic patients. Scand J Gas-troenterol, 51(3): 344-353.
23. Seo SI, Kim HS, Kim WJ, et al (2015). Diagnostic val-ue of PIVKA-II and alpha-fetoprotein in hepatitis B virus-associated hepatocellular carcinoma. World J Gastroenterol, 21(13): 3928-3935.
24. Abdel-Aziz MM, Elshal MF, Abass AT, et al (2016). Comparison of AFP-L3 and p53 Antigen Con-centration with Alpha-Fetoprotein as Serum Markers for Hepatocellular Carcinoma. Clin Lab, 62(6): 1121-1129.
25. Okuyama M, Ueno H, Kobayashi Y, et al (2016). Target-selective photo-degradation of AFP-L3 and selective photo-cytotoxicityagainst HuH-7 hepatocarcinoma cells using an anthraquinone-PhoSL hybrid. Chem Commun (Camb), 52(10): 2169-2172.
26. Subwongcharoen S, Leelawat K, Treepongkaruna SA, Narong S (2011). Serum AFP and AFP-L3 in clinically distinguished hepatocellular carcino-mafrom patients with liver masses. J Med Assoc Thai, 94 Suppl 2: S46-51.
27. Hiraoka A, Ishimaru Y, Kawasaki H, et al (2015). Tumor Markers AFP, AFP-L3, and DCP in Hepatocellular Carcinoma Refractory to Trans catheter Arterial Chemoembolization. Oncology, 89(3): 167-174.
28. Zhao J, Guo LY, Yang JM, et al (2015). Sublingual vein parameters, AFP, AFP-L3, and GP73 in pa-tients with hepatocellular carcinoma. Genet Mol Res,14(2): 7062-7067.
29. Choi J, Kim GA, Han S, et al (2019). Longitudinal Assessment of Three Serum Biomarkers to De-tect Very Early-Stage Hepatocellular Carcinoma. Hepatology, 69(5): 1983-1994.
IssueVol 50 No 8 (2021) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijph.v50i8.6806
Primary hepatic carcinoma Ultrasound Multislice Spiral CT Alpha-fetoprotein receptor Combination examination

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How to Cite
Zhao X, Xia Y, Li C, Wang D. Efficacy Evaluation on the Color Doppler Ultrasound, Multislice Spiral CT Combined with Serum Markers in Diagnosis of Primary Hepatic Carcinoma. Iran J Public Health. 2021;50(8):1603-1612.