title: A lexicon for hepatocellular carcinoma surveillance ultrasonography: benign versus malignant lesions.
abstract: OBJECTIVE
  To suggest a lexicon for liver ultrasonography and to identify radiologic features indicative of benign or malignant lesions on surveillance ultrasonography.
  
  
  METHODS
  This retrospective study included 188 nodules (benign, 101; malignant, 87) from 175 at-risk patients identified during surveillance ultrasonography for hepatocellular carcinoma. We created a lexicon for liver ultrasonography by reviewing relevant literature regarding the ultrasonographic features of hepatic lesions. Using this lexicon, two abdominal radiologists determined the presence or absence of each ultrasonographic feature for the included hepatic lesions. Independent factors associated with malignancy and interobserver agreement were determined by logistic regression analysis and kappa statistics, respectively.
  
  
  RESULTS
  Larger tumor size (odds ratio [OR], 1.12; 95% confidence interval [CI], 1.06-1.183;P<0.001), multinodular confluent morphology (OR, 7.712; 95% CI, 1.053-56.465;P=0.044), thick hypoechoic rim (OR, 5.878; 95% CI, 2.681-12.888;P<0.001), and posterior acoustic enhancement (OR, 3.077; 95% CI, 1.237-7.655;P=0.016) were independently associated with malignant lesions. In a subgroup analysis of lesions <2 cm, none of the ultrasonographic features were significantly associated with malignancy or benignity. Interobserver agreement for morphology was fair (κ=0.36), while those for rim (κ=0.427), echogenicity (κ=0.549), and posterior acoustic enhancement (κ=0.543) were moderate.
  
  
  CONCLUSIONS
  For hepatic lesions larger than 2 cm, some ultrasonography (US) features might be suggestive of malignancy. We propose a lexicon that may be useful for surveillance US.
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Chansik
authors.initials: C
authors.lastname: An
authors.affiliation: Department of Oncology and Radiology, Tashkent Medical Academy, Tashkent, Uzbekistan.
authors.forename: Gulbahor
authors.initials: G
authors.lastname: Rakhmonova
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Kyunghwa
authors.initials: K
authors.lastname: Han
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Nieun
authors.initials: N
authors.lastname: Seo
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Jin Young
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Myeong-Jin
authors.initials: MJ
authors.lastname: Kim
authors.affiliation: Department of Radiology, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Mi-Suk
authors.initials: MS
authors.lastname: Park
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000737:chemistry; D003937:Diagnosis, Differential; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: D003287:Contrast Media; D000509:alpha-Fetoproteins
keywords: Carcinoma, Hepatocellular; Surveillance; Ultrasonography