LI-RADS 4 or 5 categorization may not be clinically relevant for decision-making processes: A prospective cohort study

• Published in: Annals of hepatology Vol. 19; no. 6; pp. 662 - 667
• Main Authors: Piñero, Federico, Thompson, Marcos A., Diaz Telli, Federico, Trentacoste, Juan, Padín, Carlos, Mendizabal, Manuel, Colaci, Carla, Gonzalez Campaña, Ariel, Pages, Josefina, Montal, Silvina, Barreiro, Mariano, Fauda, Martín, Podestá, Gustavo, Perotti, Juan Pablo, Silva, Marcelo
• Format: Journal Article
• Language: English
• Published: Elsevier España, S.L.U 01.11.2020; Elsevier
• Subjects: Explant; Hepatocellular carcinoma; Histology; LI-RADS; Liver transplant; Probability; Probability; Liver transplant; Explant; Hepatocellular carcinoma; Histology; LI-RADS
• ISSN: 1665-2681; 2659-5982
• DOI: 10.1016/j.aohep.2020.06.007

▪ The liver imaging reporting data system (LI-RADS) for hepatocellular carcinoma (HCC) was proposed to standardize and enhance consensus of reporting. However, clinical utility of LI-RADS has not been evaluated in Latin America. We therefore sought to compare LI-RADS categories with histopathology findings in liver transplant (LT) explants in a regional center. Prospective cohort study conducted between 2012 and 2018 in a single center from Argentina including patients with HCC listed for LT. LI-RADS definitions were applied to magnetic resonance images (MRI) or computed tomography (CT) abdominal scans at time of listing and at final pre-LT reassessment and compared to explant pathology findings; specifically, major nodule (NOD1). Of 130 patients with HCC listed for LT (96.1% with cirrhosis and 35.6% with hepatitis C virus infection), 72 underwent LT. Overall, 65% had imaging HCC diagnosis based on MRI (n = 84), 26% with CT (n = 34) and 9% (n = 12) with both methods. Among LT patients with pre-transplant imaging at our institution (n = 42/72), 69% of the NOD1 were LR-5, 21% LR-4 and 10% LR-3. Definite HCC diagnosis was 50% in LR-3 NOD1 (CI 18–90); none presented microvascular invasion. In LR-4 NOD1, HCC was confirmed in 89% (CI 59–98), of which 11% showed microvascular invasion; whereas in LR-5 NOD1 77% (CI 64–87) had confirmed HCC, 17% with microvascular invasion. LI-RADS was useful to standardize reports; however, no significant differences were observed between LR-4 and LR-5 HCC probability when compared to explant pathology.