Joint Consensus Statement of the Indian National Association for Study of the Liver and Indian Radiological and Imaging Association for the Diagnosis and Imaging of Hepatocellular Carcinoma Incorporating Liver Imaging Reporting and Data System

Abstract

Hepatocellular carcinoma (HCC) is the 6th most common cancer and the second most common cause of cancerrelated mortality worldwide. There are currently no universally accepted practice guidelines for the diagnosis of HCC on imaging owing to the regional differences in epidemiology, target population, diagnostic imaging modalities, and staging and transplant eligibility. Currently available regional and national guidelines include those from the American Association for the Study of Liver Disease (AASLD), the European Association for the Study of the Liver (EASL), the Asian Pacific Association for the Study of the Liver, the Japan Society of Hepatology, the Korean Liver Cancer Study Group, Hong Kong, and the National Comprehensive Cancer Network in the United States. India with its large population and a diverse health infrastructure faces challenges unique to its population in diagnosing HCC. Recently, American Association have introduced a Liver Imaging Reporting and Data System (LIRADS, version 2017, 2018) as an attempt to standardize the acquisition, interpretation, and reporting of liver lesions on imaging and hence improve the coherence between radiologists and clinicians and provide guidance for the management of HCC. The aim of the present consensus was to find a common ground in reporting and interpreting liver lesions pertaining to HCC on imaging keeping LIRADSv2018 in mind. (

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“…1 In India, the total cases of men and women suffering HCC accounts for 0.7 to 7.5 and 0.2 to 2.2, respectively, per 1 lakh person per annum. 2 It is believed that surgical resection is the only optimal treatment for HCC, as it is not always feasible since most of the patients are diagnosed with the disease in an advanced or intermediate stage of hepatic cancer. Also, traditional chemotherapy has a helpless endurance rate with extreme reactions due to lack of tumor selectivity, dose-dependent toxicity, low selectivity, and resistance development.…”

“…Hepatocellular carcinoma (HCC) is the sixth prevailing global health problem and the third cancer-related cause of death worldwide each year . In India, the total cases of men and women suffering HCC accounts for 0.7 to 7.5 and 0.2 to 2.2, respectively, per 1 lakh person per annum . It is believed that surgical resection is the only optimal treatment for HCC, as it is not always feasible since most of the patients are diagnosed with the disease in an advanced or intermediate stage of hepatic cancer.…”

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“…of AFP is still around 60% and is fluctuating in chronic HBV or HCV patients, it may not be recommended as a surveillance test [5].…”

“…More than 60% of HCCs are found in developing countries, with approximately 50% of the cases in China are linked to HBV [ 2–4 ]. A standardized Liver Imaging Reporting and Data System for interpretation, reporting and data collection of imaging studies has been used for patients at the risk for developing HCC since 2008, improving the coherence between radiologists and clinicians and provide guidance for the management of HCC [ 5 ]. In Asia, where the prevalence of HCC is high, it is recommended to perform a combination of ultrasound and alpha-fetoprotein (AFP) measurements [ 6 , 7 ].…”

“…It is suggested that AFP is a screening and diagnostic tool for HCC detection [ 9 ]. However, since the diagnostic sensitivity of AFP is still around 60% and is fluctuating in chronic HBV or HCV patients, it may not be recommended as a surveillance test [ 5 ].…”