Moctezuma-Velázquez Carlos, Lewis Sara, Lee Karen, Amodeo Salvatore, Llovet Josep M, Schwartz Myron, Abraldes Juan G, Villanueva Augusto
Department of Gastroenterology, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico.
Liver Cancer Translational Research Group, Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
JHEP Rep. 2021 Sep 16;3(6):100364. doi: 10.1016/j.jhepr.2021.100364. eCollection 2021 Dec.
BACKGROUND & AIMS: Criteria defined by the European Association for the Study of the Liver (EASL) and Liver Imaging Reporting and Data System (LI-RADS) enable hepatocellular carcinoma (HCC) diagnosis based on imaging in cirrhosis. Non-cirrhotic patients require biopsy given the lower pre-test probability of HCC. The objective of our study was to assess the performance of EASL and LI-RADS criteria for the diagnosis of HCC in non-cirrhotic patients with chronic HBV infection.
This was a cross-sectional study performed at a referral center. We included all patients with HBV without cirrhosis with focal liver lesions who underwent contrast-enhanced CT or MRI at our clinic between 2005-2018. Studies were reviewed by 2 radiologists blinded to the diagnosis.
We included 280 patients, median age was 56.8 (IQR 48.2-65.45) years and 223 (80%) were male. In 191 (79%) cases the lesion was found as a result of screening. Cirrhosis was excluded based on pathology in 252 (90%) cases. We assessed 338 nodules: 257 (76%) HCC, 40 (12%) non-HCC malignant lesions, and 41 (12%) benign lesions. EASL criteria and LR-5/LR-tumor-in-vein (TIV) categories had a 100% agreement in categorizing lesions as HCC, and 226 nodules (67%) were classified as HCCs. The sensitivity, specificity, positive predictive value, and negative predictive value were 82.1 (76.9-86.6), 81.5 (71.3-89.2), 93.4 (89.3-96.2), and 58.9 (49.2-68.1), respectively. When the pre-test probability of HCC is >70%, estimated as a PAGE-B score above 9, and EASL or LR-5/LR-TIV criteria are met, post-test probability would be >90%.
EASL criteria and LR-5/LR-TIV categories show a positive predictive value in patients with HBV without cirrhosis that is comparable to that seen in patients with cirrhosis. These criteria can be used when the pre-test probability of HCC is >70%.
Current guidelines recommend performing a biopsy to confirm the diagnosis of presumed hepatocellular carcinoma (HCC) in patients without cirrhosis. We showed that specific imaging criteria had a 100% agreement for categorizing lesions as HCC, with a positive predictive value of 93.4%. These imaging criteria could be used to diagnose HCC in HBV patients without cirrhosis with a pre-test probability of HCC of ≥70%, avoiding the need for a liver biopsy.
欧洲肝脏研究协会（EASL）和肝脏影像报告及数据系统（LI-RADS）所定义的标准能够基于肝硬化患者的影像学检查诊断肝细胞癌（HCC）。鉴于HCC的检测前概率较低，非肝硬化患者需要进行活检。我们研究的目的是评估EASL和LI-RADS标准在诊断慢性HBV感染的非肝硬化患者HCC中的性能。
这是一项在转诊中心进行的横断面研究。我们纳入了2005年至2018年间在我们诊所接受对比增强CT或MRI检查的所有无肝硬化的HBV患者，这些患者有肝脏局灶性病变。由2名对诊断不知情的放射科医生对研究进行评估。
我们纳入了280例患者，中位年龄为56.8（四分位间距48.2 - 65.45）岁，223例（80%）为男性。在191例（79%）病例中，病变是筛查发现的。根据病理排除肝硬化的有252例（90%）。我们评估了338个结节：257个（76%）为HCC，40个（12%）为非HCC恶性病变，41个（12%）为良性病变。EASL标准和LR-5/LR-肿瘤累及静脉（TIV）类别在将病变分类为HCC方面有100%的一致性，226个结节（67%）被分类为HCC。敏感性、特异性、阳性预测值和阴性预测值分别为82.1（76.9 - 86.6）、81.5（71.3 - 89.2）、93.4（89.3 - 96.2）和58.9（49.2 - 68.1）。当HCC的检测前概率>70%（估计PAGE-B评分高于9）且符合EASL或LR-5/LR-TIV标准时，检测后概率将>90%。
EASL标准和LR-5/LR-TIV类别在无肝硬化的HBV患者中显示出与肝硬化患者相当的阳性预测值。当HCC的检测前概率>70%时可使用这些标准。
当前指南建议对无肝硬化的疑似肝细胞癌（HCC）患者进行活检以确诊。我们发现特定的影像学标准在将病变分类为HCC方面有100%的一致性，阳性预测值为93.4%。这些影像学标准可用于诊断HCC检测前概率≥70%的无肝硬化HBV患者，从而避免肝脏活检的必要性。
