Predictors of hepatocellular carcinoma in LR-M category lesions, a multi-institutional analysis.

PURPOSE: The Liver Imaging Reporting and Data System (LI-RADS, LR) provides a framework for diagnosing hepatocellular carcinoma (HCC, LR-5). However, not all HCCs meet LR-5 criteria and are instead categorized as LR-M, probably or definitely malignant but not specific for HCC, necessitating biopsy for diagnosis. The purpose is to identify factors associated with HCC in LR-M observations. METHODS: This is an IRB-approved, retrospective analysis of participants from 8 institutions that had a LR-M observation on CT or MRI with corresponding histopathologic diagnosis. Demographics and biochemical data were examined. Central review using the LI-RADS v2018 algorithm was performed. Kappa statistics defined inter-reader agreement. Random forest and logistic regression analyses generated a model for HCC diagnosis. RESULTS: 162 participants with 162 LR-M observations were included. 46% of observations (74/162) were HCC and 37% were cholangiocarcinoma (60/162). Two of 34 imaging features- observation size and intra-lesion iron- showed moderate to strong inter-reader agreement (Kappa ≥ 0.60) while the remainder showed weak or no agreement (Kappa < 0.60). Random forest analysis showed biochemical features to be more predictive of HCC than imaging features. Logistic regression analysis of a model based on INR and AFP provided a 72% sensitivity and 61% specificity for HCC by Youden's index and a 90% specificity threshold yielded 38% sensitivity, 75% positive predictive value, and 66% negative predictive value. CONCLUSIONS: Our results show INR and AFP are associated with HCC in LR-M observations. A high-specificity threshold may assist in the non-invasive diagnosis of HCC in the appropriate setting. In certain at-risk patients with a LR-M observation on diagnostic imaging, serum AFP and INR maybe useful tools for the non-invasive diagnosis of HCC.

Duke Scholars

Author Brian C Allen Radiology, Abdominal Imaging

Author Diana Marcella Cardona Pathology

Author Andrew Joseph Muir Medicine, Gastroenterology

Author Tracy Anne Jaffe Radiology, Abdominal Imaging

Author Omobonike Oyindasola Oloruntoba Medicine, Gastroenterology

Author Kevin Ryan Kalisz Radiology, Abdominal Imaging

Author Mustafa Shadi Rifaat Bashir Radiology, Abdominal Imaging