Value of conventional ultrasonography and contrast-enhanced ultrasound in the differential diagnosis of intrahepatic cholangiocellular carcinoma and hepatocellular carcinoma: An analysis based on the logistic regression model

Objective To investigate the value of conventional ultrasonography( US) and contrast-enhanced ultrasound( CEUS) in the differential diagnosis of intrahepatic cholangiocellular carcinoma( ICC) and hepatocellular carcinoma( HCC) by establishing a logistic regression model with the variables of US features and CEUS enhancement pattern( circumferential ring enhancement). Methods A retrospective analysis was performed for the US and CEUS features of 55 ICC patients and 42 HCC patients,and the results of surgical pathology or biopsy were used as the golden standard for diagnosis. A logistic regression analysis was used to evaluate the value of four US features,lesion echo,blood supply type,bile duct dilatation,and circumferential ring enhancement of CEUS,in the differential diagnosis of ICC and HCC. The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups. A binary logistic regression analysis was performed for the factors with statistical significance in univariate analysis. Likelihood ratio was used to evaluate the fitting of the whole model,and the feature with the highest likelihood ratio in the qualitative diagnosis of ICC was screened out. The receiver operating characteristic( ROC) curve was plotted for the logistic regression model in the qualitative diagnosis of ICC,and the area under the ROC curve( AUC) was calculated. Results There were significant differences between the two groups in lesion echo( χ2= 4. 813,P < 0. 05),blood supply type( χ2= 10. 222,P < 0. 01),bile duct dilatation( χ2= 40. 669,P < 0. 01),and circumferential ring enhancement of CEUS( χ2= 8. 180,P < 0. 01),and these four features had a sensitivity of 58. 15%,72. 73%,67. 27%,and 69. 09%,respectively,and a specificity of 64. 29%,59. 52%,66. 4%,and 95. 24%,respectively,all P < 0. 05,in the differential diagnosis of ICC and HCC. Type of lesion echo,blood supply,circumferential ring enhancement of CEUS,and presence or absence of bile duct dilatation had an odds ratio of 3. 556,4. 107,4. 223,and 5. 776,respectively. The binary logistic regression equation was Logistic( P) =-2. 761 + 1.272 X1 + 1. 430 X2 + 1. 538 X3 + 1. 743 X4. The likelihood-ratio test of this model showed a significant difference in this regression equation( χ2= 94. 691,P < 0. 001). In the qualitative diagnosis of ICC,this regression equation had a sensitivity of 74. 3%,a specificity of 82. 2%,and an AUC of 0. 856. There was a significant difference in time to peak between the two groups( t = 8. 497,P < 0. 01). Conclusion The logistic regression model and CEUS qualitative analysis can improve the qualitative diagnosis of ICC.