Tzu-Hao Lee1,2, Nathan Hirshman3, Diana M Cardona4, Carl L Berg3,5, Kathryn J Fowler6, Mustafa R Bashir5,7,8, James Ronald9. 1. Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, 6620 Main St, Suite 1450, Houston, TX, 77030, USA. 2. Division of Abdominal Transplant, Department of Surgery, Baylor College of Medicine, 6620 Main St, Suite 1450, Houston, TX, 77030, USA. 3. Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27710, USA. 4. Department of Pathology, Duke University Medical Center, 1000 Trent Dr, Durham, NC, 27710, USA. 5. Division of Gastroenterology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA. 6. Department of Radiology, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA. 7. Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA. 8. Center for Advanced Magnetic Resonance Development, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA. 9. Department of Radiology, Duke University Medical Center, 2301 Erwin Rd, Durham, NC, 27710, USA. james.ronald@duke.edu.
Abstract
BACKGROUND: Liver Imaging Reporting and Data System (LI-RADS) classifies liver nodules from LR-1 to LR-5 based on risk for hepatocellular carcinoma (HCC). It is challenging to know the nature of the LR-3 and LR-4 lesions. AIMS: To test our hypothesis that in patients with a definite HCC (LR-5) or treated HCC (LR-TR), a coexisting LR-3 or LR-4 lesion is more likely to represent HCC compared to patients without LR-5 or LR-TR lesions. METHODS: We conducted a retrospective study including all adult patients who received liver transplantation in our institution from 1/1/2014 to 3/3/2020 who had any LR-3 or LR-4 lesion on pre-transplant MRI. RESULTS: Seventy-eight patients were included in the final cohort (115 LR-3 and LR-4 lesions total). When accompanied by LR-5 or LR-TR lesions, 41% (28/69) of LR-3 lesions were HCC compared to 12% (3/25) when not accompanied by LR-5 LR-TR lesions. When accompanied by LR-5 or LR-TR lesions, 83% (10/12) of LR-4 lesions were HCC, versus 33% (3/9) when not accompanied by LR-5 or LR-TR lesions. In a multivariable analysis of all lesions, the presence of a LR-5 or LR-TR lesion was significantly associated with LR-3 or LR-4 lesions representing HCC (OR 6.4, p = 0.01). CONCLUSION: LR-3 and LR-4 lesions are more likely to be HCC in patients with LR-5 or LR-TR lesions. The presence of coexisting definite HCC may be a useful diagnostic feature to improve risk stratification of lesions without typical imaging features of HCC. This may also affect decision-making prior to liver transplant when HCC burden must be accurately determined.
BACKGROUND: Liver Imaging Reporting and Data System (LI-RADS) classifies liver nodules from LR-1 to LR-5 based on risk for hepatocellular carcinoma (HCC). It is challenging to know the nature of the LR-3 and LR-4 lesions. AIMS: To test our hypothesis that in patients with a definite HCC (LR-5) or treated HCC (LR-TR), a coexisting LR-3 or LR-4 lesion is more likely to represent HCC compared to patients without LR-5 or LR-TR lesions. METHODS: We conducted a retrospective study including all adult patients who received liver transplantation in our institution from 1/1/2014 to 3/3/2020 who had any LR-3 or LR-4 lesion on pre-transplant MRI. RESULTS: Seventy-eight patients were included in the final cohort (115 LR-3 and LR-4 lesions total). When accompanied by LR-5 or LR-TR lesions, 41% (28/69) of LR-3 lesions were HCC compared to 12% (3/25) when not accompanied by LR-5 LR-TR lesions. When accompanied by LR-5 or LR-TR lesions, 83% (10/12) of LR-4 lesions were HCC, versus 33% (3/9) when not accompanied by LR-5 or LR-TR lesions. In a multivariable analysis of all lesions, the presence of a LR-5 or LR-TR lesion was significantly associated with LR-3 or LR-4 lesions representing HCC (OR 6.4, p = 0.01). CONCLUSION: LR-3 and LR-4 lesions are more likely to be HCC in patients with LR-5 or LR-TR lesions. The presence of coexisting definite HCC may be a useful diagnostic feature to improve risk stratification of lesions without typical imaging features of HCC. This may also affect decision-making prior to liver transplant when HCC burden must be accurately determined.
Authors: Janice L Atkins; Luke C Pilling; Jane A H Masoli; Chia-Ling Kuo; Jeremy D Shearman; Paul C Adams; David Melzer Journal: JAMA Date: 2020-11-24 Impact factor: 56.272
Authors: Christian B van der Pol; Christopher S Lim; Claude B Sirlin; Trevor A McGrath; Jean-Paul Salameh; Mustafa R Bashir; An Tang; Amit G Singal; Andreu F Costa; Kathryn Fowler; Matthew D F McInnes Journal: Gastroenterology Date: 2018-11-13 Impact factor: 22.682
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