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. 2024 Sep 17:14:1360936.
doi: 10.3389/fonc.2024.1360936. eCollection 2024.

Development and validation of a digital biopsy model to predict microvascular invasion in hepatocellular carcinoma

Emrullah Birgin  1 , Heiner Nebelung  2 , Schaima Abdelhadi  3 , Johann S Rink  4 , Matthias F Froelich  4 , Svetlana Hetjens  5 , Mohammad Rahbari  3 , Patrick Téoule  3 , Erik Rasbach  3 , Christoph Reissfelder  3   6 , Jürgen Weitz  7 , Stefan O Schoenberg  4 , Carina Riediger  7 , Verena Plodeck  2 , Nuh N Rahbari  1
Affiliations

Development and validation of a digital biopsy model to predict microvascular invasion in hepatocellular carcinoma

Emrullah Birgin et al. Front Oncol. .

Abstract

Background: Microvascular invasion is a major histopathological risk factor of postoperative recurrence in patients with hepatocellular carcinoma. This study aimed to develop and validate a digital biopsy model using imaging features to predict microvascular invasion before hepatectomy.

Methods: A total of 217 consecutive patients who underwent hepatectomy for resectable hepatocellular carcinoma were enrolled at two tertiary-care reference centers. An imaging-based digital biopsy model was developed and internally validated using logistic regression analysis with adjustments for age, sex, etiology of disease, size and number of lesions.

Results: Three imaging features, i.e., non-smoothness of lesion margin (OR = 16.40), ill-defined pseudocapsula (OR = 4.93), and persistence of intratumoral internal artery (OR = 10.50), were independently associated with microvascular invasion and incorporated into a prediction model. A scoring system with 0 - 3 points was established for the prediction model. Internal validation confirmed an excellent calibration of the model. A cutoff of 2 points indicates a high risk of microvascular invasion (area under the curve 0.87). The overall survival and recurrence-free survival stratified by the risk model was significantly shorter in patients with high risk features of microvascular invasion compared to those patients with low risk of microvascular invasion (overall survival: median 35 vs. 75 months, P = 0.027; recurrence-free survival: median 17 vs. 38 months, P < 0.001)).

Conclusion: A preoperative assessment of microvascular invasion by digital biopsy is reliable, easily applicable, and might facilitate personalized treatment strategies.

Keywords: biomarker; hepatectomy; perioperative oncology; radiology; resection.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Patient flow chart.
Figure 2
Figure 2
Digital biopsy features of microvascular invasion. The digital biopsy features (i.e. internal artery, nonsmooth margin, irregular pseudocapsula) are illustrated with white arrows (CT, computed tomography; MRI, magnetic resonance imaging; AP, arterial phase; PVP, portal venous phase).
Figure 3
Figure 3
Receiver Operating Characteristics (ROC) curves of the digital biopsy microvascular invasion predictive system. The digital biopsy model with 0- to 3 points (yielded an area under the curve (AUC) of 0.91 (95% CI 0.93 - 0.99) (A). An AUC of 0.87 (95% CI 0.81 - 0.94) was calculated for the digital biopsy risk model with high vs. low risk of microvascular invasion (B).
Figure 4
Figure 4
Survival plot stratified by pathologic and digital biopsy of microvascular invasion. The overall and recurrence-free survival plots of histopathological MVI (A, B) and digital biopsy proven MVI (C, D) are displayed.
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