Distinguishing focal nodular hyperplasia from hepatocellular adenoma on contrast-enhanced ultrasound: a systematic review and meta-analysis.
L Shen, S Altmayer, J R Tse
✦ AI-curated · Sources linked
In 30 seconds
This systematic review and meta-analysis assessed contrast-enhanced ultrasound (CEUS) for distinguishing focal nodular hyperplasia (FNH) from hepatocellular adenoma (HCA), using histopathology or MRI with hepatobiliary contrast as reference standards. Five studies included 228 FNHs and 155 HCAs. Pooled CEUS sensitivity was 84.9% (95% CI, 69.8-93.2%) and specificity was 84.1% (95% CI, 74.8-90.4%); the area under the summary receiver-operating characteristic curve was 0.90 (95% CI, 0.80-0.93). The authors considered the findings promising but exploratory.
Key findings
- Across five studies, pooled CEUS sensitivity for distinguishing FNH from HCA was 84.9% (95% CI, 69.8-93.2%).
- Pooled specificity was 84.1% (95% CI, 74.8-90.4%), with an AUC of 0.90 (95% CI, 0.80-0.93).
- The evidence comprised 228 FNHs and 155 HCAs; MRI with hepatobiliary contrast was the reference standard in four studies.
Why it matters
Distinguishing FNH from HCA is a diagnostic task for which CEUS may offer useful performance. These pooled estimates provide a broader assessment than the modest-sized single-centre studies described by the authors, while the uncertainty and reference-standard mix are important when interpreting accuracy in clinical evaluation.
What to keep in mind
Only five studies were included, and three were at overall low risk of bias, with concerns mainly about patient selection. Most studies used MRI with hepatobiliary contrast rather than histology as the reference standard; the authors describe the findings as exploratory.