Hepatology and Liver Unit, Hospital Universitario Austral, School of Medicine, Austral University, Buenos Aires, Argentina; Latin American Liver Research Educational and Awareness Network (LALREAN), Buenos Aires, Argentina.
Hepatology and Liver Unit, Hospital Universitario Austral, School of Medicine, Austral University, Buenos Aires, Argentina.
Ann Hepatol. 2020 Nov-Dec;19(6):662-667. doi: 10.1016/j.aohep.2020.06.007. Epub 2020 Jul 16.
The liver imaging reporting data system (LI-RADS) for hepatocellular carcinoma (HCC) was proposed to standardize and enhance consensus of reporting. However, clinical utility of LI-RADS has not been evaluated in Latin America. We therefore sought to compare LI-RADS categories with histopathology findings in liver transplant (LT) explants in a regional center.
Prospective cohort study conducted between 2012 and 2018 in a single center from Argentina including patients with HCC listed for LT. LI-RADS definitions were applied to magnetic resonance images (MRI) or computed tomography (CT) abdominal scans at time of listing and at final pre-LT reassessment and compared to explant pathology findings; specifically, major nodule (NOD1).
Of 130 patients with HCC listed for LT (96.1% with cirrhosis and 35.6% with hepatitis C virus infection), 72 underwent LT. Overall, 65% had imaging HCC diagnosis based on MRI (n = 84), 26% with CT (n = 34) and 9% (n = 12) with both methods. Among LT patients with pre-transplant imaging at our institution (n = 42/72), 69% of the NOD1 were LR-5, 21% LR-4 and 10% LR-3. Definite HCC diagnosis was 50% in LR-3 NOD1 (CI 18-90); none presented microvascular invasion. In LR-4 NOD1, HCC was confirmed in 89% (CI 59-98), of which 11% showed microvascular invasion; whereas in LR-5 NOD1 77% (CI 64-87) had confirmed HCC, 17% with microvascular invasion.
LI-RADS was useful to standardize reports; however, no significant differences were observed between LR-4 and LR-5 HCC probability when compared to explant pathology.
肝脏影像报告数据系统（LI-RADS）用于肝细胞癌（HCC）旨在规范和增强报告的一致性。然而，LI-RADS 在拉丁美洲的临床应用尚未得到评估。因此，我们旨在比较区域中心肝移植（LT）标本中 LI-RADS 分类与组织病理学发现。
2012 年至 2018 年，在阿根廷的一个单中心进行了前瞻性队列研究，纳入 HCC 患者，这些患者已被列入 LT 名单。在列入名单时和最终 LT 前重新评估时，LI-RADS 定义应用于磁共振成像（MRI）或腹部 CT 扫描，并与标本病理学发现进行比较；特别是主要结节（NOD1）。
130 名 HCC 患者被列入 LT 名单（96.1%有肝硬化，35.6%有丙型肝炎病毒感染），其中 72 名接受 LT。总体而言，65%的患者根据 MRI（n=84）诊断为 HCC，26%的患者根据 CT（n=34）诊断为 HCC，9%（n=12）的患者同时采用两种方法诊断。在我们机构接受 LT 患者中（n=42/72），69%的 NOD1 为 LR-5，21%为 LR-4，10%为 LR-3。LR-3 NOD1 中明确 HCC 诊断率为 50%（CI 18-90）；无一例出现微血管侵犯。LR-4 NOD1 中，HCC 确诊率为 89%（CI 59-98），其中 11%存在微血管侵犯；LR-5 NOD1 中，77%（CI 64-87）的患者 HCC 得到确诊，17%的患者存在微血管侵犯。
LI-RADS 有助于规范报告；然而，与组织病理学相比，LR-4 和 LR-5 HCC 可能性之间未观察到显著差异。
