The importance of a nonsmooth tumor margin and incomplete tumor capsule in predicting HCC microvascular invasion on preoperative imaging examination: a systematic review and meta-analysis

Published:December 03, 2020DOI:


      • MVI is an important predictor of early postoperative recurrence of hepatocellular carcinoma.
      • Non-smooth tumor margin and incomplete tumor capsule in radiology to help predict MVI in HCC preoperatively
      • Reference for the development of diagnostic criteria for MVI



      Microvascular invasion (MVI) is a key factor affecting the prognosis of hepatocellular carcinoma (HCC). Preoperative imaging plays an important role in the diagnosis of HCC, treatment planning and treatment evaluation, but it is still difficult to detect MVI directly. Whether the appearance of the tumor margin and the capsule on radiological images can predict MVI is still controversial. The aim of this study is to explore the correlation of the presence of MVI with the smoothness of the tumor margin and the integrity of the capsule in HCC.

      Materials and methods

      The PubMed, Embase, Medline, SCI and Cochrane Library databases up to January 2020. Heterogeneity among studies was assessed by sensitivity analysis, subgroup analysis and meta-regression, and the influence of threshold effects was also analyzed.


      Eleven studies with 1618 patients were included. The results of the meta-analysis indicated that there was a significant relationship between MVI and nonsmooth tumor margin (DOR = 4.62 [2.73, 7.81]) and between MVI and incomplete tumor capsule (DOR = 2.25 [1.22, 4.15]); the sensitivity and specificity of these two parameters were 0.757 [0.602, 0.865], 0.597 [0.450, 0.728] and 0.646 [0.455, 0.800], 0.552 [0.419, 0.678], respectively. We drew the receiver operating characteristic (ROC) curves, and the area under curve (AUC) of the nonsmooth tumor margin variable for predicting MVI was 0.72 [0.69, 0.77], and the AUC of the incomplete tumor capsule variable for predicting MVI was 0.62 [0.58, 0.66].


      Nonsmooth tumor margins and incomplete tumor capsules observed by imaging are important for the preoperative prediction of MVI in HCC.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Imaging
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Popat K.
        • McQueen K.
        • Feeley T.W.
        The global burden of cancer.
        Best Pract Res Clin Anaesthesiol. 2013-Dec 2013; 27: 399-408
      1. D. J. Erstad and K. K. Tanabe, "Prognostic and therapeutic implications of microvascular invasion in hepatocellular carcinoma," Annals of Surgical Oncology, Review vol. 26, no. 5, pp. 1474–1493, 2019.

      2. M. Rodriguez-Peralvarez, T. V. Luong, L. Andreana, T. Meyer, A. P. Dhillon, and A. K. Burroughs, "A systematic review of microvascular invasion in hepatocellular carcinoma: diagnostic and prognostic variability," Annals of Surgical Oncology, Review vol. 20, no. 1, pp. 325–339, Jan 2013.

      3. A. Rastogi, "Changing role of histopathology in the diagnosis and management of hepatocellular carcinoma," World Journal of Gastroenterology, Review vol. 24, no. 35, pp. 4000–4013, Sep 2018.

        • Baheti A.D.
        • et al.
        Clinical implications for imaging of vascular invasion in hepatocellular carcinoma.
        Abdominal Radiology. 2016; 41 (Sep): 1800-1810
      4. M. Ni et al., "Radiomics models for diagnosing microvascular invasion in hepatocellular carcinoma: which model is the best model?," Cancer Imaging, vol. 19, no. 1, Aug 2019, Art. no. 60.

      5. X. Zhang, J. Li, F. Shen, and W. Y. Lau, "Significance of presence of microvascular invasion in specimens obtained after surgical treatment of hepatocellular carcinoma," Journal of Gastroenterology & Hepatology, Review vol. 33, no. 2, pp. 347–354, 2018.

        • Wu T.-H.
        • et al.
        A non-smooth tumor margin on preoperative imaging predicts microvascular invasion of hepatocellular carcinoma.
        Surg Today. 2016; 46 (Nov): 1275-1281
      6. H. K. Hussain, D. C. Barr, and C. Wald, "Imaging techniques for the diagnosis of hepatocellular carcinoma and the evaluation of response to treatment," Semin Liver Dis, vol. 34, no. 4, pp. 398–414, Nov 2014.

        • Wei Y.
        • et al.
        IVIM improves preoperative assessment of microvascular invasion in HCC.
        Eur Radiol. Oct 2019; 29 (in eng): 5403-5414
      7. H. Zhao et al., "Prognostic value and preoperative predictors of microvascular invasion in solitary hepatocellular carcinoma <= 5 cm without macrovascular invasion," Oncotarget, vol. 8, no. 37, pp. 61203–61214, Sep 5 2017.

      8. H. Zhao et al., "Development and validation of a novel predictive scoring model for microvascular invasion in patients with hepatocellular carcinoma," (in eng), Eur J Radiol, vol. 88, pp. 32–40, Mar 2017.

        • Chen P.
        • Lu J.
        • Zhang T.
        • Zhang X.
        • Liang H.
        • Miao X.
        The value of gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced MRI in the prediction of microvascular invasion of hepatocellular carcinoma. [Chinese].
        Chinese Journal of Radiology (China). 10 Feb 2019; 53: 103-108
        • Zhu F.
        • Yang F.
        • Li J.
        • Chen W.
        • Yang W.
        Incomplete tumor capsule on preoperative imaging reveals microvascular invasion in hepatocellular carcinoma: a systematic review and meta-analysis.
        Abdominal Radiology. 15 Sep 2019; 44: 3049-3057
      9. A. Reginelli et al., "Can microvascular invasion in hepatocellular carcinoma be predicted by diagnostic imaging? A critical review," (in eng), Future Oncol, vol. 14, no. 28, pp. 2985–2994, Dec 2018.

        • Zhu W.
        • Qing X.C.
        • Yan F.
        • Luo Y.
        • Li Y.Z.
        • Zhou X.
        Can the contrast-enhanced ultrasound washout rate be used to predict microvascular invasion in hepatocellular carcinoma?.
        Ultrasound in Medicine and Biology. 2017; 43 (Aug): 1571-1580
        • Hu H.T.
        • et al.
        Ultrasound-based radiomics score: a potential biomarker for the prediction of microvascular invasion in hepatocellular carcinoma.
        Eur Radiol. Jun 2019; 29 (in eng): 2890-2901
        • Lim C.
        • et al.
        18F-FDG PET/CT predicts microvascular invasion and early recurrence after liver resection for hepatocellular carcinoma: a prospective observational study.
        HPB (Oxford). Jun 2019; 21 (in eng): 739-747
        • Cuccurullo V.
        • Di Stasio G.D.
        • Mazzarella G.
        • Cascini G.L.
        Microvascular invasion in HCC: the molecular imaging perspective.
        Contrast Media & Molecular Imaging, Review. 2018; 2018: 9487938
      10. Z. Lei et al., "Nomogram for preoperative estimation of microvascular invasion risk in hepatitis B virus-related hepatocellular carcinoma within the Milan criteria," JAMA Surgery, Research Support, Non-US Gov't vol. 151, no. 4, pp. 356–63, 2016.

        • Yang L.
        • et al.
        A Radiomics nomogram for preoperative prediction of microvascular invasion in hepatocellular carcinoma.
        Liver Cancer. Oct 2019; 8 (in eng): 373-386
      11. X. Xu et al., "Radiomic analysis of contrast-enhanced CT predicts microvascular invasion and outcome in hepatocellular carcinoma," (in eng), J Hepatol, vol. 70, no. 6, pp. 1133–1144, Jun 2019.

      12. S. X. Gao, R. Liao, H. Q. Wang, D. Liu, and F. Luo, "A nomogram predicting microvascular invasion risk in BCLC 0/A hepatocellular carcinoma after curative resection," (in eng), Biomed Res Int, vol. 2019, p. 9264137, 2019.

        • Wang W.T.
        • et al.
        Assessment of microvascular invasion of hepatocellular carcinoma with diffusion kurtosis imaging.
        Radiology. Feb 2018; 286 (in eng): 571-580
        • Huang M.
        • et al.
        Prediction of microvascular invasion in hepatocellular carcinoma: preoperative Gd-EOB-DTPA-dynamic enhanced MRI and histopathological correlation.
        Contrast Media & Molecular Imaging. 2018; 2018 (Clinical Trial Research Support, Non-U.S. Gov’t): 9674565
        • Zhang W.
        • Wang P.
        • Wang L.
        • Liu L.
        • Chen J.
        • Su D.
        Preoperative computed tomography and serum alpha-fetoprotein to predict microvascular invasion in hepatocellular carcinoma.
        Medicine (United States). 01 Jul 2018; 97 (no pagination)e11402
      13. S. Lee, S. H. Kim, J. E. Lee, D. H. Sinn, and C. K. Park, "Preoperative gadoxetic acid-enhanced MRI for predicting microvascular invasion in patients with single hepatocellular carcinoma," (in eng), J Hepatol, vol. 67, no. 3, pp. 526–534, Sep 2017.