Clinicopathologic and ultrasonographic features of combined hepatocellular-cholangiocarcinoma and its correlation with microvascular invasion: a predictive role of contrast-enhanced ultrasound

Background: This study aims to investigate the clinicopathological and ultrasonography characteristics of combined hepatocellular-cholangiocarcinoma (cHCC-CCA) and its correlation with microvascular invasion (MVI), as well as the predictive value of contrast-enhanced ultrasound (CEUS) imaging.

Methods: A retrospective analysis was conducted on 57 patients diagnosed with cHCC-CCA between November 2017 and May 2023 at Guizhou Provincial People's Hospital. Among them, 27 patients were MVI-positive and 30 patients were MVI-negative, all of whom underwent preoperative CEUS within 2 weeks. Clinical data, ultrasonographic findings, and CEUS features were compared between the two groups to analyze the influencing factors and predictive value of MVI in cHCC-CCA patients.

Results: Compared to the MVI-negative group, the MVI-positive group showed a higher proportion of tumors with a maximum diameter greater than 5 cm, elevated alpha-fetoprotein (AFP) levels, low echo halo around the tumor, non-smooth tumor contour, peripheral irregular rim-like enhancement and early washout (≤60s) with nodular patterns on CEUS (P<0.05). Multivariate logistic regression analysis revealed that low echo halo, peripheral irregular rim-like enhancement, and early washout were independent risk factors for MVI in cHCC-CCA patients. The receiver operating characteristic (ROC) curve analysis demonstrated an area under the curve (AUC) of 0.8056 for these factors.

Conclusions: Ultrasonographic and CEUS features have a certain correlation with MVI in cHCC-CCA patients. Low echo halo, peripheral irregular rim-like enhancement, and early washout are independent risk factors for MVI in patients with cHCC-CCA. These features have a predictive value in determining the presence of MVI in patients with cHCC-CCA.