Optimal criteria for hepatocellular carcinoma diagnosis using CT in patients undergoing liver transplantation
- 245 Downloads
To compare the diagnostic performance of various guidelines for hepatocellular carcinoma (HCC) diagnosis using computed tomography (CT) in patients undergoing liver transplantation (LT).
In total, 216 patients who underwent preoperative CT and subsequent LT were included. Two radiologists retrospectively evaluated focal hepatic lesions independently according to various guidelines and allocated patients according to the Milan criteria. The diagnostic performance of the guidelines was compared using alternative free-response receiver-operating characteristics (AFROC) analysis with bootstrapping. Comparisons of sensitivity, specificity, and accuracy of patient allocation based on the Milan criteria between guidelines were performed using logistic regression with generalized estimating equations (GEE).
Fifty-two of 216 patients had 87 HCCs. The reader-averaged figure of merit obtained using AFROC analysis was 0.738 for the AASLD/EASL or KLCSG-NCC guidelines and 0.728 for the LI-RADS v2014 or OPTN/UNOS (bootstrapping, p = 0.005). The per-lesion sensitivity for HCCs (all and 1–2-cm lesions) was significantly higher with the AASLD/EASL (37.9–41.4% and 30.8–41.0%) than with LI-RADS (28.7% and 15.4–18.0%) (logistic regression with GEE, p = 0.008 and 0.030 for reader 1 and p = 0.005 for reader 2). The per-patient specificity (98.8–99.4%) was the same for all guidelines. The accuracy of the Milan criteria was 81.5–83.3% without significant differences among the four guidelines (logistic regression with GEE, p > 0.05).
AASLD/EASL showed higher diagnostic performance and sensitivity, particularly for 1–2-cm HCCs, and the same specificity with LI-RADS. All guidelines are comparable for patient allocation based on the Milan criteria for LT.
• The overall diagnostic performance of CT for HCC diagnosis was highest with AASLD/EASL.
• AASLD/EASL showed higher sensitivity for diagnosis of 1–2-cm HCCs than LI-RADS.
• The accuracy of the Milan criteria using CT was comparable among the four guidelines.
KeywordsCarcinoma, hepatocellular Liver transplantation ROC curve Sensitivity and specificity Tomography, X-ray computed
American Association for the Study of Liver Diseases
Alternative free-response receiver operating characteristics
European Association for the Study of the Liver
European Organization for Research and Treatment of Cancer
Figure of merit
Generalized estimating equation
Korean Liver Cancer Study Group and the National Cancer Center
Liver Imaging Reporting and Data System
Magnetic resonance imaging
Organ Procurement and Transplant Network
United Network for Organ Sharing
The authors state that this work has not received any funding.
Compliance with ethical standards
The scientific guarantor of this publication is Mi-Suk Park.
Conflict of interest
The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
Statistics and biometry
Kyunghwa Han from Yonsei Biomedical Research Institute, who is one of the coauthors, performed statistical analysis.
Written informed consent was waived by the Institutional Review Board.
Institutional Review Board approval was obtained.
• diagnostic study
• performed at one institution
- 7.American College of Radiology. Liver imaging reporting and data system (LI-RADS). American College of Radiology. Web site. http://www.acr.org/Quality-Safety/Resources/LIRADS/LIRADS-v2014. Accessed June 1, 2017
- 13.Kokudo N, Hasegawa K, Akahane M et al (2015) Evidence-based Clinical Practice Guidelines for Hepatocellular Carcinoma: The Japan Society of Hepatology 2013 update (3rd JSH-HCC Guidelines). Hepatol Res 45Google Scholar
- 15.Tang A, Fowler KJ, Chernyak V, Chapman WC, Sirlin CB (2017) LI-RADS and transplantation for hepatocellular carcinoma. Abdom Radiol (NY). https://doi.org/10.1007/s00261-017-1210-8
- 16.Lee DH, Lee JM, Baek JH, Shin CI, Han JK, Choi BI (2015) Diagnostic performance of gadoxetic acid-enhanced liver MR imaging in the detection of HCCs and allocation of transplant recipients on the basis of the Milan criteria and UNOS guidelines: correlation with histopathologic findings. Radiology 274:149–160CrossRefGoogle Scholar
- 19.Zhai X, Chakraborty DP (2015). RJafroc: Analysis of data acquired using the receiver operating characteristic paradigm and its extensions. R package version 0.1.1. https://CRAN.R-project.org/package=RJafroc
- 20.Ronot M, Fouque O, Esvan M, Lebigot J, Aube C, Vilgrain V (2017) Comparison of the accuracy of AASLD and LI-RADS criteria for the non-invasive diagnosis of HCC smaller than 3cm. J Hepatol. https://doi.org/10.1016/j.jhep.2017.12.014
- 27.Luca A, Caruso S, Milazzo M et al (2010) Multidetector-row computed tomography (MDCT) for the diagnosis of hepatocellular carcinoma in cirrhotic candidates for liver transplantation: prevalence of radiological vascular patterns and histological correlation with liver explants. Eur Radiol 20:898–907CrossRefGoogle Scholar
- 33.Heimbach J, Kulik LM, Finn R et al (2017) Aasld guidelines for the treatment of hepatocellular carcinoma. Hepatology. https://doi.org/10.1002/hep.29086
- 34.Roberts LR, Sirlin CB, Zaiem F et al (2017) Imaging for the Diagnosis of Hepatocellular Carcinoma: a Systematic Review and Meta-analysis. Hepatology. https://doi.org/10.1002/hep.29487