The index sAGP is valuable for distinguishing atypical hepatocellular carcinoma from atypical benign focal hepatic lesions

Abstract

Abstract Objective The differential diagnosis of atypical hepatocellular carcinoma (aHCC) and atypical benign focal hepatic lesions (aBFHL) usually depends on pathology. This study aimed to develop non-invasive approaches based on conventional blood indicators for the differential diagnosis of aHCC and aBFHL. Methods Hospitalized patients with pathologically confirmed focal hepatic lesions and their clinical data were retrospectively collected, in which patients with HCC with serum alpha-fetoprotein (AFP) levels of ≤ 200 ng/mL and atypical imaging features were designated as the aHCC group (n = 224), and patients with benign focal hepatic lesions without typical imaging features were designated as the aBFHL group (n = 178). The performance of indexes (both previously reported and newly constructed) derived from conventional blood indicators by four mathematic operations in distinguishing aHCC and aBFHL was evaluated by the receiver operating characteristic (ROC) curve and diagnostic validity metrics. Results Among previously reported derived indexes, the index GPR, the ratio of γ-glutamyltransferase(GGT) to platelet (PLT), showed the best performance in distinguishing aHCC from aBFHL with the area under ROC curve (AUROC) of 0.853 (95% CI 0.814-0.892), but the other indexes were of little value (AUROCs from 0.531 to 0.700). A new derived index, sAGP [(sAFP+sGGT)/sPLT], was developed using standardized three conventional blood indicators and exhibited AUROCs of 0.905, 0.894, 0.891, 0.925, and 0.862 in differentiating overall, BCLC stage 0/A, TNM stage I, small, and AFP-negative aHCC from aBFHL, respectively. Conclusion The sAGP index is an efficient, simple and practical metric for the non-invasive differentiation of aHCC from aBFHL.