Abstract
Simple SummaryThe European (EASL) and American (AASLD) guidelines for the management of hepatocellular carcinoma (HCC) suggest different management of nodules with indeterminate imaging in cirrhosis. In particular, nodules classified as LR-3 and LR-4 by the CEUS LI-RADS algorithm (indeterminate for HCC) are suggested to be biopsied according the EASL guidelines, but may be only monitored with follow-up imaging, with biopsy left to selected LR-4/LR-M cases, according to the AASLD ones. The present study shows that CEUS LI-RADS classes LR-3 and LR-4 HCC have no better clinical outcome than typical HCC (LR-5). Such data support the EASL policy, aimed at conclusive diagnostic investigations of indeterminate nodules up to obtaining histological proof to avoid leaving aggressive HCC not timely treated.The American College of Radiology (ACR) released the Liver Imaging Report and Data System (LI-RADS) scheme, which categorizes hepatic nodules in risk classes from LR-1 to LR-5 (according to the degree of risk to be HCC) and LR-M (probable malignancy not specific for HCC). The aim of this study was to test whether HCC with different LR patterns on CEUS have different overall survival (OS) and recurrence-free survival (RFS). We retrospectively enrolled 167 patients with the first definitive diagnosis of single HCC (by using CT/MRI or histological techniques if CT/MRI were inconclusive) for whom CEUS examination was available. The median size of HCC lesions was 2.2 cm (range 1.0–7.2 cm). According to CEUS LI-RADS classification, 28 patients were in LR-3, 48 in LR-4, 83 in LR-5, and 8 in LR-M. Patient liver function and nodule characteristics were not statistically different between CEUS LI-RADS classes. Using univariate analysis, CEUS LI-RADS class was not found to be a predictor of survival (p = 0.347). In conclusion, HCC showing the CEUS LI-RADS classes LR-3 and LR-4 have no better clinical outcome than typical HCC. Such data support the EASL policy, aimed at conclusive diagnostic investigations of indeterminate nodules up to obtaining histological proof to avoid leaving aggressive HCC not timely treated.
Highlights
The American College of Radiology (ACR)—Liver Imaging Reporting and Data System (LI-RADS) [1] is an algorithm that categorizes patients with liver nodules at risk for hepatocellular carcinoma (HCC) in different classes according to the degree of risk of nodules to be HCC and was initially designed for CT or MRI characteristics
One patient had histological proof of HCC after Contrast-enhanced ultrasonography (CEUS) had showed a pattern not typical for HCC (LR-4), but he did not receive CT/MRI imaging in our center, and radiological images and reports could not be retrieved, so he was included with CEUS only
The present study shows that HCC nodules with different CEUS Liver Imaging Report and Data System (LI-RADS) patterns have no different prognosis in terms of overall survival corresponding to no better biological behavior of HCC with indeterminate pattern (LR-3 and LR-4) than HCC with typical radiologic pattern (LR-5)
Summary
The American College of Radiology (ACR)—Liver Imaging Reporting and Data System (LI-RADS) [1] is an algorithm that categorizes patients with liver nodules at risk for hepatocellular carcinoma (HCC) in different classes according to the degree of risk of nodules to be HCC and was initially designed for CT or MRI characteristics. It subgroups patients in different classes of risk of having HCC and namely LR-1 (definitely benign), LR-2 (probably benign), LR-3 (intermediate probability for HCC), LR-4 (probably HCC), LR-5 (definitely HCC), and LR-M (probable malignancy not specific for HCC). The recent published EASL guidelines [6] reintroduced CEUS in the diagnostic flow-chart of liver nodules (in particular in case of inconclusive or contraindicated CT/MRI), and recommend biopsies for all the nodules without the HCC imaging hallmarks
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