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

Piñero, Federico; Thompson, Marcos; Telli, Federico Díaz; Trentacoste, Juan Francisco; Padin, Carlos Juan; Mendizábal, Manuel; Colaci, Carla; Campaña, Ariel Gonzalez; Pages, Josefina; Montal, Silvina; Barreiro, Mariano; Fauda, Martín; Podestá, Gustavo; Perotti, Juan Pablo; Silva, Marcelo

doi:10.1016/j.aohep.2020.06.007

Cited by 12 publications

(16 citation statements)

References 18 publications

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“…Similar conclusions have been suggested by another single-institution experience on a retrospective cohort of 72 patients undergoing LT [ 10 ], which highlighted a non-negligible prevalence of HCC (89%) and MVI (11%) in LR-4 observations, with not-statistically significant difference between LR-4 and LR-5 classes.…”

Section: Discussionsupporting

confidence: 88%

“…Moreover, it is important to highlight out how up to 22.6% of LR-3/4 observations in our cohort presented MVI, that has been already demonstrated as one of the most unfavorable histological features affecting worse oncological outcomes [ 26 ]. Another interesting finding was also represented by a non-negligible percentage of satellitosis (9.4%) and capsule infiltration (11.3%) even in LR-3/4 classes, supporting the need of cautious management of these intermediate-risk classes, as already suggested from other recently published studies [ 8 , 9 , 10 , 22 ].…”

Section: Discussionsupporting

confidence: 77%

“…Another interesting finding was the identification of a non-negligible percentage of MVI (22.6%), satellitosis (9.4%) and capsule infiltration (11.3%) in LR-3/4 observations, supporting the need for a cautious evaluation and management of such intermediate-risk classes, as already advocated by other authors [ 8 , 9 , 10 , 22 ].…”

Section: Discussionsupporting

confidence: 71%

“…Given this scenario, recent evidence supported a potential role of LI-RADS protocol on clinical decision making in the setting of HCC ablation vs. resection [ 8 ] and liver transplantation [ 9 , 10 ], suggesting an association of LI-RADS classes with specific pathological features of HCC nodules.…”

Section: Introductionmentioning

confidence: 99%

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From LI-RADS Classification to HCC Pathology: A Retrospective Single-Institution Analysis of Clinico-Pathological Features Affecting Oncological Outcomes after Curative Surgery

et al. 2022

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Background: The latest Liver Imaging Reporting and Data System (LI-RADS) classification by the American College of Radiology has been recently endorsed in the American Association for the Study of Liver Disease (AASLD) guidelines for Hepatocellular carcinoma (HCC) management. Although the LI-RADS protocol has been developed as a diagnostic algorithm, there is some evidence concerning a possible correlation between different LI-RADS classes and specific pathological features of HCC. We aimed to investigate such radiological/pathological correlation and the possible prognostic implication of LI-RADS on a retrospective cohort of HCC patients undergoing surgical resection. Methods: We performed a retrospective analysis of the pathological characteristics of resected HCC, exploring their distribution among different LI-RADS classes and analyzing the risk factors for recurrence-free, overall and cancer-specific survival Results: LI-RADS-5 (LR-5) nodules showed a higher prevalence of microvascular invasion (MVI), satellitosis and capsule infiltration, as well as higher median values of alpha-fetoprotein (αFP) compared to LI-RADS-3/4 (LR-3/4) nodules. MVI, αFP, satellitosis and margin-positive (R1) resection resulted as independent risk factors for recurrence-free survival, while LI-RADS class did not exert any significant impact. Focusing on overall survival, we identified patient age, Eastern Cooperative Oncology Group performance status (ECOG-PS), Model for End Stage Liver Disease (MELD) score, αFP, MVI, satellitosis and R1 resection as independent risk factors for survival, without any impact of LI-RADS classification. Last, MELD score, log10αFP, satellitosis and R1 resection resulted as independent risk factors for cancer-specific survival, while LI-RADS class did not exert any significant impact. Conclusions: Our results suggest an association of LR-5 class with unfavorable pathological characteristics of resected HCC; tumor histology and underlying patient characteristics such as age, ECOG-PS and liver disease severity exert a significant impact on postoperative oncological outcomes.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 77%

Section: Discussionsupporting

confidence: 71%

Section: Introductionmentioning

confidence: 99%

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From LI-RADS Classification to HCC Pathology: A Retrospective Single-Institution Analysis of Clinico-Pathological Features Affecting Oncological Outcomes after Curative Surgery

et al. 2022

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“…The LI-RADS algorithm assumes that radiological findings are an imperfect measure of complete tumor necrosis (Chernyak et al 2018 ; Voizard et al 2019b ). It is still unclear how responses measured by LR-TR criteria reflect patient outcomes, given the risk of minimal residual disease and tumor recurrence (Piñero et al 2020 ). A few pilot studies that aimed to investigate the performance of the LR-TR for prediction of tumor necrosis following locoregional treatment have been published; however, the majority investigated only a single session of locoregional therapy (namely, transcatheter bland embolization or ablation), and a low number of patients received multiple treatment sessions (Gervais 2019 ; Chaudhry et al 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Performance of initial LI-RADS 2018 treatment response in predicting survival of patients with hepatocellular carcinoma following TACE: a retrospective, single-center cohort study

Bartnik

Podgórska

Rosiak

et al. 2021

J Cancer Res Clin Oncol

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Purpose Treatment response following transarterial chemoembolization (TACE) is frequently evaluated with Liver Imaging Reporting and Data System Treatment Response (LR-TR) algorithm, but its association with patients’ outcomes is not supported in the literature. The purpose of this study was to provide such data. Methods A retrospective analysis of 99 TACE patients with stage A/B hepatocellular carcinoma according to Barcelona-Clinic Liver Cancer staging system was performed. Two radiologists assessed LR-TR, while a third radiologist re-assessed divergent results. Overall survival (OS) and time to disease progression (TTP) were the primary endpoints of the study, while the Cox proportional hazard model was used for outcome analyses. Results Interobserver agreement was substantial between the two readers with κ = 0.69 (95% CI 0.58–0.81). The median OS in viable, equivocal, and non-viable groups were 27, 27, and 73 months, respectively (p < 0.001). However, after adjustment for confounding factors, there was no significant association between initial viable response and OS (HR 0.98 [95% CI 0.37–2.63], p = 0.97), while equivocal response remained statistically significant (HR 3.52. [95% CI 1.27–9.71], p = 0.015). No significant association was noted when viable and equivocal groups were analyzed in aggregate (HR 1.03 [95% CI 0.4–2.4], p = 0.96). The median TTP did not differ between non-viable and viable groups (23 vs 18 months, respectively; p = 0.98). None of the analyzed predictors was associated with TTP. Conclusion Initial LR-TR response was not an independent predictor for OS nor TTP. The preliminary results suggest the necessity for more aggressive management of equivocal patients.

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Is concurrent LR-5 associated with a higher rate of hepatocellular carcinoma in LR-3 or LR-4 observations? An individual participant data meta-analysis

Abedrabbo,

Lerner,

Lam

et al. 2024

Abdom Radiol

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

Cited by 12 publications

References 18 publications

From LI-RADS Classification to HCC Pathology: A Retrospective Single-Institution Analysis of Clinico-Pathological Features Affecting Oncological Outcomes after Curative Surgery

From LI-RADS Classification to HCC Pathology: A Retrospective Single-Institution Analysis of Clinico-Pathological Features Affecting Oncological Outcomes after Curative Surgery

Performance of initial LI-RADS 2018 treatment response in predicting survival of patients with hepatocellular carcinoma following TACE: a retrospective, single-center cohort study

Is concurrent LR-5 associated with a higher rate of hepatocellular carcinoma in LR-3 or LR-4 observations? An individual participant data meta-analysis

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