Fang-Ying Mm Fan

Objective To systematically review and evaluate the evidence supporting the role of Liver Imaging Reporting and Data System (LI-RADS) ancillary features (AFs) in optimizing hepatocellular carcinoma (HCC) diagnosis across magnetic resonance imaging (MRI), computed tomography (CT), and contrast-enhanced ultrasound (CEUS) modalities, with a focus on their incremental value in specific clinical scenarios. Methods A comprehensive literature search was performed across PubMed and Embase from 2011 to 2024 to identify studies on LI-RADS AFs. Significant ancillary features (SAFs)—a review-specific descriptive framework rather than an official LI-RADS category—were defined as features demonstrating a statistically significant contribution to HCC diagnosis or LI-RADS diagnostic performance in at least one included study (p < 0.05). Results A total of 101 articles were included. In terms of imaging modality distribution, MRI was predominant (91.1%, 92/101), while CT (21.8%, 22/101) and CEUS (9.9%, 10/101) studies were relatively limited. For LI-RADS categories LR-1 to LR-5, fourteen SAFs were identified on MRI (e.g., hepatobiliary phase hypointensity, diffusion restriction). For lesions ≤ 3 cm, the incremental value of applying a single guideline-recommended AF was marginal. In contrast, applying combinations of ≥ 4 AFs significantly improved sensitivity by 10.6–18.3% without a significant loss of specificity. Evidence for CT-based AFs was limited and inconsistent. For CEUS LR-1 to LR-5 observations, six AFs were identified, with exploratory markers showing potential incremental value, whereas the two official AFs showed inconsistent performance. For LR-M lesions, 14 SAFs significantly contributed to differentiating HCC from other hepatic malignancies (p < 0.05). In treatment response assessment (TRA), five SAFs—two of which are guideline-recommended—improved diagnostic sensitivity by 3.2–42.8% without loss of specificity. Conclusion LI-RADS AFs enhance HCC diagnostic accuracy when complementing major features, with the most robust evidence supporting MRI-based AFs. In contrast, AFs based on CT and CEUS require further validation.

Background: Fever is a common side effect following thermal ablation in patients with hepatocellular carcinoma (HCC), yet its impact on prognosis remains unclear. Materials and Methods: This retrospective study included initial HCC patients who underwent US-guided percutaneous microwave ablation at 13 hospitals between January 2006 and February 2021. All patients were categorized into afebrile, transient low-grade fever (TLF), and prolonged or high-grade fever (PHF) groups. Primary outcomes included very early recurrence (VER) and early recurrence (ER), secondary outcomes were disease-free survival (DFS) and overall survival (OS). Fever cut-offs for VER/ER were established using restrictive cubic splines and an adjusted Cox model. Survival analyses used the Kaplan–Meier method. Results: A total of 1458 initial HCC patients (mean age, 59±11[SD]; 1146 men). Compared to afebrile individuals, patients with TLF (temperatures ranging 37.0–38.8°C for 1–2 days), showed independent protective effects against VER (HR, 0.73; 95% CI: 0.57–0.95; P =0.02) and ER (HR, 0.66; 95% CI: 0.54–0.81; P P =0.96) and ER (HR, 0.86; 95% CI: 0.69–1.07; P =0.17). With a median follow-up of 47 months (IQR: 26–79), the median DFS for TLF patients was 40 months, superior to afebrile (30 months, P =0.019) and PHF patients (33 months, P =0.049). The 5-year OS rate for TLF patients was 73.2%, higher than afebrile (69.3%, P =0.02) and PHF patients (66.7%, P =0.03). No significant difference was found in DFS and OS between afebrile and PHF patients ( P =0.90 and 0.71). Notably, TLF patients exhibited the highest lymphocyte counts increasing median 7 days after ablation ( P P =0.01 vs. PHF). Conclusion: Transient low-grade fever following percutaneous microwave ablation in hepatocellular carcinoma patients demonstrated protection against early recurrence, possibly attributed to the short-term activation of lymphocytes.

Objective To evaluate the efficacy, safety, and improvement of symptoms by ultrasound-guided microwave ablation (MWA) for patients with large benign thyroid nodules (BTNs). Methods Eighty-seven patients with 87 BTNs (≥ 4 cm) treated with MWA between April 2015 and March 2021 were enrolled in this retrospective multicenter study, with clinical and ultrasound examinations performed at the 1st, 3rd, 6th, and 12th months. A multivariable linear mixed effects model was employed to explore the alterations in volume and volume reduction ratio (VRR), as well as the potential factors associated with VRR. Results The mean age of the 87 patients was 45.69 ± 14.21 years (range 18–76 years), and the ratio of men to women was 1:4.8. The mean volumes were much decreased at the 12th month after ablation compared to the initial volumes (p < .001). The mean VRR was 76.09% at the 12th month. The technique efficacy (VRR > 50%) was 90.80% at the 12th month. A multivariate analysis revealed that VRR was related to the initial volume (p = .015), annular flow (p = .010), and nodule composition (p = .024). The mean symptomatic score decreased from 4.40 ± 0.28 to 0.26 ± 0.06 at the 12th month (p < .001). At the same time, the mean cosmetic score decreased from 3.22 ± 0.10 to 1.31 ± 0.08 (p < .001). Conclusion MWA could serve as a safe and effective therapy for large BTNs, significantly reducing the volume of BTNs and significantly improving compressive symptoms and appearance problems. Clinical relevance statement Microwave ablation could serve as a safe and effective therapy for large benign thyroid nodules, leading to significant volume reduction and satisfied symptom and cosmetic alleviation period. Key Points • This multicenter study investigated the feasibility and safety of microwave ablation for large benign thyroid nodules. • After ablation, the nodule volume was significantly reduced, and patients’ symptoms and appearance problems were significantly improved. • Microwave ablation is feasible for large benign thyroid nodules and has been a supplement treatment.