{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T01:38:15Z","timestamp":1790300295469,"version":"4.1.0"},"reference-count":31,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T00:00:00Z","timestamp":1611532800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003196","name":"Ministero della Salute","doi-asserted-by":"publisher","award":["Fondi Ricerca Corrente L3P1"],"award-info":[{"award-number":["Fondi Ricerca Corrente L3P1"]}],"id":[{"id":"10.13039\/501100003196","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>The differential diagnosis of hepatic cystic echinococcosis (CE) may be challenging. When imaging is insufficient, serology can be applied, but no consensus diagnostic algorithm exists. We evaluated the performances of nine serological tests commercialized in Europe for the diagnosis of \u201cechinococcosis\u201d. We performed a diagnostic accuracy study using a panel of sera from patients with hepatic CE (n = 45 \u201cliquid\u201d content stages, n = 25 \u201csolid\u201d content stages) and non-CE focal liver lesions (n = 54 with \u201cliquid\u201d content, n = 11 with \u201csolid\u201d content). The diagnosis and staging of CE were based on ultrasound (gold standard). Nine commercial seroassays (5 ELISA, 2 WB, 1 Chemiluminescence Immunoassay [CLIA] and 1 Immunochromatographic test [ICT]) were the index tests. Sensitivity (Se) ranged from 43 to 94% and from 31 to 87%, and specificity (Sp) from 68 to 100% and from 94 to 100%, when borderline results were considered positive or negative, respectively. Three seroassays (2 ELISA, 1 WB) were excluded from further analyses due to poor performances. When tests were combined, Sp was 98\u2013100%. The best results were obtained using the WB-LDBIO alone (Se 83%) or as a third test after two non-WB tests (Se 67\u201386%). A validated WB or two non-WB tests, read with stringent criteria (borderline = negative and considered positive only if concordant positive), possibly confirmed by the WB, appear sensible approaches.<\/jats:p>","DOI":"10.3390\/diagnostics11020167","type":"journal-article","created":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T09:59:40Z","timestamp":1611568780000},"page":"167","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":31,"title":["Evaluation of Nine Commercial Serological Tests for the Diagnosis of Human Hepatic Cyst Echinococcosis and the Differential Diagnosis with Other Focal Liver Lesions: A Diagnostic Accuracy Study"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0478-3914","authenticated-orcid":false,"given":"Francesca","family":"Tamarozzi","sequence":"first","affiliation":[{"name":"Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2447-1777","authenticated-orcid":false,"given":"Silvia Stefania","family":"Longoni","sequence":"additional","affiliation":[{"name":"Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambra","family":"Vola","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Infectious Diseases, IRCCS San Matteo Hospital Foundation, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monica","family":"Degani","sequence":"additional","affiliation":[{"name":"Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Tais","sequence":"additional","affiliation":[{"name":"Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleonora","family":"Rizzi","sequence":"additional","affiliation":[{"name":"Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Prato","sequence":"additional","affiliation":[{"name":"Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2956-8997","authenticated-orcid":false,"given":"Salvatore","family":"Scarso","sequence":"additional","affiliation":[{"name":"Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2852-2287","authenticated-orcid":false,"given":"Ronaldo","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrico","family":"Brunetti","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences and Infectious Diseases, IRCCS San Matteo Hospital Foundation, 27100 Pavia, Italy"},{"name":"Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9530-8742","authenticated-orcid":false,"given":"Zeno","family":"Bisoffi","sequence":"additional","affiliation":[{"name":"Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy"},{"name":"Department of Diagnostics and Public Health, University of Verona, 37129 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Perandin","sequence":"additional","affiliation":[{"name":"Department of Infectious Tropical Diseases and Microbiology, IRCCS Sacro Cuore Don Calabria Hospital, 37024 Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1016\/j.pt.2019.05.006","article-title":"Echinococcus granulosus sensu lato","volume":"35","author":"Casulli","year":"2019","journal-title":"Trends Parasitol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/bs.apar.2016.11.001","article-title":"Global distribution of alveolar and cystic echinococcosis","volume":"95","author":"Deplazes","year":"2017","journal-title":"Adv. Parasitol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/bs.apar.2016.09.002","article-title":"Echinococcosis: Control and prevention","volume":"96","author":"Craig","year":"2017","journal-title":"Adv. Parasitol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/bs.apar.2016.09.006","article-title":"The echinococcoses: Diagnosis, clinical management and burden of disease","volume":"96","author":"Kern","year":"2017","journal-title":"Adv. Parasitol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.actatropica.2009.11.001","article-title":"Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans","volume":"114","author":"Brunetti","year":"2010","journal-title":"Acta Trop."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1097\/QCO.0000000000000485","article-title":"Clinical management of cystic echinococcosis: State of the art and perspectives","volume":"31","author":"Weber","year":"2018","journal-title":"Curr. Opin. Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/bs.apar.2016.09.003","article-title":"Laboratory diagnosis of Echinococcus spp. in human patients and infected animals","volume":"96","author":"Casulli","year":"2017","journal-title":"Adv. Parasitol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1007\/s13149-017-0548-z","article-title":"Rapid diagnostic tests for the serodiagnosis of human cystic echinococcosis","volume":"110","author":"Tamarozzi","year":"2017","journal-title":"Bull. Soc. Pathol. Exot."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"741","DOI":"10.1007\/s00436-009-1707-3","article-title":"Serological reactivity of patients with Echinococcus infections (E. granulosus, E. vogeli, and E. multilocularis) against three antigen B subunits","volume":"106","author":"Yamano","year":"2010","journal-title":"Parasitol. Res."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3718","DOI":"10.1128\/JCM.38.10.3718-3721.2000","article-title":"Immunodiagnosis of Echinococcus infections: Confirmatory testing and species differentiation by a new commercial Western Blot","volume":"38","author":"Liance","year":"2000","journal-title":"J. Clin. Microbiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e000036","DOI":"10.1136\/bmjgast-2015-000036","article-title":"Pitfalls in diagnosis and treatment of alveolar echinococcosis: A sentinel case series","volume":"2","author":"Stojkovic","year":"2015","journal-title":"BMJ Open Gastroenterol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1128\/CVI.00363-07","article-title":"Usefulness of four different Echinococcus granulosus recombinant antigens for serodiagnosis of unilocular hydatid disease (UHD) and postsurgical follow-up of patients treated for UHD","volume":"15","author":"Muro","year":"2008","journal-title":"Clin. Vaccine Immunol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"166","DOI":"10.4269\/ajtmh.15-0219","article-title":"Factors influencing the serological response in hepatic Echinococcus granulosus infection","volume":"94","author":"Lissandrin","year":"2016","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.4269\/ajtmh.19-0556","article-title":"Diagnostic performances of commercial ELISA, Indirect Hemagglutination, and Western Blot in differentiation of hepatic echinococcal and non-echinococcal lesions: A retrospective analysis of data from a single referral centre","volume":"101","author":"Vola","year":"2019","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_15","unstructured":"(2020, November 10). Equator Network. Available online: https:\/\/www.equator-network.org\/reporting-guidelines\/stard\/."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Chebli, H., El Laamrani Idrissi, A., Benazzouz, M., Lmimouni, B.E., Nhammi, H., Elabandouni, M., Youbi, M., Afifi, R., Tahiri, S., and El Feydi, A.E. (2017). Human cystic echinococcosis in Morocco: Ultrasound screening in the Mid Atlas through an Italian-Moroccan partnership. PLoS Negl. Trop. Dis., 11.","DOI":"10.1371\/journal.pntd.0005384"},{"key":"ref_17","first-page":"4","article-title":"Hepatic hemangioma-review","volume":"8","author":"Bajenaru","year":"2015","journal-title":"J. Med. Life"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1007\/s00261-015-0605-7","article-title":"Prevalence of benign focal liver lesions: Ultrasound investigation of 45,319 hospital patients","volume":"41","author":"Kaltenbach","year":"2016","journal-title":"Abdom. Radiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3543","DOI":"10.3748\/wjg.v19.i23.3543","article-title":"Evaluation of hepatic cystic lesions","volume":"19","author":"Lantinga","year":"2013","journal-title":"World J. Gastroenterol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"11","DOI":"10.3748\/wjg.v26.i1.11","article-title":"Hepatic hemangioma: What internists need to know","volume":"26","author":"Leon","year":"2020","journal-title":"World J. Gastroenterol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1016\/j.dld.2015.09.016","article-title":"Prevalence and clinical outcome of hepatic haemangioma with specific reference to the risk of rupture: A large retrospective cross-sectional study","volume":"48","author":"Mocchegiani","year":"2016","journal-title":"Dig. Liver Dis."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"22","DOI":"10.5114\/ceh.2019.83153","article-title":"An updated review of cystic hepatic lesions","volume":"5","author":"Rawla","year":"2019","journal-title":"Clin. Exp. Hepatol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"611","DOI":"10.1016\/S0035-9203(99)90068-8","article-title":"Field diagnosis of Echinococcus granulosus infection among intermediate and definitive hosts in an endemic focus of human cystic echinococcosis","volume":"93","author":"Moro","year":"1999","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"462","DOI":"10.4269\/ajtmh.1999.60.462","article-title":"An extensive ultrasound and serologic study to investigate the prevalence of human cystic echinococcosis in northern Libya","volume":"60","author":"Shambesh","year":"1999","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/j.medmal.2018.11.011","article-title":"Review of European and American guidelines for the diagnosis of Lyme borreliosis","volume":"49","author":"Eldin","year":"2019","journal-title":"Med. Mal. Infect."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1007\/s10096-011-1393-9","article-title":"Dealing with initial inconclusive serological results for chronic Chagas disease in clinical practice","volume":"31","author":"Lapa","year":"2012","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"20","DOI":"10.1016\/j.diagmicrobio.2017.06.002","article-title":"Large-scale evaluation of a rapid diagnostic test for human cystic echinococcosis","volume":"89","author":"Baraquin","year":"2017","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1007\/s00436-010-1726-0","article-title":"Application of recombinant Echinococcus granulosus antigen B to ELISA kits for diagnosing hydatidosis","volume":"106","author":"Kalantari","year":"2010","journal-title":"Parasitol. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1055\/s-0040-1716460","article-title":"Comparative evaluation of Echinococcus serology with cytology for the diagnosis of hepatic hydatid disease","volume":"12","author":"Mahajan","year":"2020","journal-title":"J. Lab. Physicians"},{"key":"ref_30","first-page":"1219","article-title":"Evaluation of immunochromatographic test for the detection of antibodies against Echinococcosis granulosus","volume":"2","author":"Tamer","year":"2015","journal-title":"Med. Sci. Monit."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"260","DOI":"10.3201\/eid1402.061101","article-title":"Diagnosis of cystic echinococcosis, central Peruvian Highlands","volume":"14","author":"Gavidia","year":"2008","journal-title":"Emerg. Infect. Dis."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/2\/167\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:15:04Z","timestamp":1760159704000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/11\/2\/167"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,25]]},"references-count":31,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,2]]}},"alternative-id":["diagnostics11020167"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics11020167","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,25]]}}}