A retrospective single‐centre analysis of the oncological impact of LI‐RADS classification applied to Metroticket 2.0 calculator in liver transplantation: every nodule matters

Abstract

Although the diagnostic value of Liver Imaging Reporting and Data System (LI-RADS) protocol is well recognized in clinical practice, its role in liver transplant (LT) setting is under-explored. We sought to evaluate the oncological impact of LI-RADS classification applied to Metroticket 2.0 calculator in a single-centre retrospective cohort of transplanted hepatocellular carcinoma (HCC) patients, exploring which LI-RADS subclasses need to be considered in order to grant the best Metroticket 2.0 performance. The most recent pre-LT imaging of 245 patients undergoing LT for HCC between 2005 and 2015 was retrospectively and blindly reviewed, classifying all nodules according to LI-RADS protocol. Metroticket 2.0 accuracy was subsequently tested incorporating all vital nodules identified during multidisciplinary team (MDT) meetings attended before LI-RADS reclassification of the latest pre-LT imaging, LR-5 and LR-treatment-viable (LR-TR-V), LR-4/5 and LR-TR-V, and LR-3/4/5 and LR-TR-V nodules respectively. Considering their extremely low probability for harbouring HCC, LR-1 and LR-2 nodules were not considered in this analysis. Incorporation of all HCCs identified during MDT meetings attended before LI-RADS reclassification of the latest pre-LT imaging resulted in a Metroticket 2.0 c-index of 0.72, [95% confidence interval (CI) 0.64-0.80]. Metroticket 2.0 c-index dropped to 0.60 [95% CI: 0.48-0.72] when LI-RADS-5 and LI-RADS-TR-V (P = 0.0089) or LI-RADS-5, LI-RADS-4 and LI-RADS-TR-V (P = 0.0068) nodules were entered in the calculator. Conversely, addition of LI-RADS-3 HCCs raised the Metroticket 2.0 c-index to 0.65 [95% CI: 0.54-0.86], resulting in a not statistically significant diversion from the original performance (0.72 vs. 0.65; P = 0.08). Exclusion of LR-3 and LR-4 nodules from Metroticket 2.0 calculator resulted in a significant drop in its accuracy. Every nodule with an intermediate-to-high probability of harbouring HCC according to LI-RADS protocol seems to contribute to tumour burden and should be entered in the Metroticket 2.0 calculator in order to grant appropriate performance.

Association between Time to Local Tumor Control and Treatment Outcomes Following Repeated Loco-Regional Treatment Session in Patients with Hepatocellular Carcinoma: A Retrospective, Single-Center Study

“…Thus, we hypothesize that the association of poorer patient outcomes with a lack of complete response after first locoregional session may be due to unfavorable baseline risk factors. It is worth to underline that the study group included only LR-5 tumors, although Centonze et al suggest that including tumors LR-3 and LR-4 in OS prediction does not significantly decrease its precision [26]. Moreover, presented results extend recent suggestions by Wang et al that the best objective response correlates better with treatment outcomes in patients with more advanced disease, as the concordance between initial and overall best response is weak in those subjects [7].…”

Radiomics Models for Predicting Microvascular Invasion in Hepatocellular Carcinoma: A Systematic Review and Radiomics Quality Score Assessment

“…The Liver Imaging Reporting and Data System (LI-RADS) has recently been developed and has evolved as a comprehensive and standardized diagnostic algorithm for HCC imaging reporting [ 6 ]. LI-RADS has been proven to be an effective tool not only for HCC diagnosis but also for outcome prediction after liver resection, radiofrequency ablation, or liver transplantation [ 6 , 7 , 8 ], exerting an increasing influence on the treatment management of HCC. Previous studies have demonstrated the diagnostic value of LI-RADS in the prediction of MVI [ 9 , 10 ].…”

Predict Early Recurrence of Resectable Hepatocellular Carcinoma Using Multi-Dimensional Artificial Intelligence Analysis of Liver Fibrosis

“…Second, although qFibrosis can provide more accurate fibrotic status than conventional histological methods, sampling error may still have some influence on the qFibrosis score. Besides, our study was unable to provide competing risk analysis as Metroticket 2.0 model used in liver transplantation patients owing to the complicated clinical situations and the study design [ 34 , 35 ]. Finally, our method needs liver tissue to obtain its qFibrosis score, so it is not a non-invasive assessment of liver fibrosis.…”