Clinical Outcomes of Patients With Suspicious (LI-RADS 4) Liver Observations

Onyirioha, Kristeen; Joshi, Sagar; Burkholder, Daniel A.; Yekkaluri, Sruthi; Parikh, Neehar D.; Singal, Amit G.; Wolf, Erin; Yokoo, Takeshi; Browning, Travis; Mendiratta‐Lala, Mishal; Rich, Nicole E.; Gopal, Purva

doi:10.1016/j.cgh.2022.03.038

Cited by 13 publications

(9 citation statements)

References 7 publications

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“…[115] Presence of these intermediate lesions is associated with elevated risk of HCC development not necessarily from the index lesions; 32% and 21% of HCC diagnoses following detection of LR-3 and LR-4 lesions were made elsewhere in the liver, respectively. [116,117] These data suggest that the presence of LR-3/LR-4 legions may have utility for HCC risk stratification. An MRI radiomic feature-based model was developed to predict 3-year HCC risk in patients with HBV cirrhosis (AUROC 0.64 in external validation).…”

Section: Imaging-based Hcc Risk Scores/ Biomarkersmentioning

confidence: 84%

“…The Liver Imaging Reporting and Data System category 3 and 4 (LR‐3, LR‐4) indicate suspicious hepatic nodules with no definite features of HCC, which are observed in one‐fourth of the patients enrolled in the HCC screening program 115. Presence of these intermediate lesions is associated with elevated risk of HCC development not necessarily from the index lesions; 32% and 21% of HCC diagnoses following detection of LR‐3 and LR‐4 lesions were made elsewhere in the liver, respectively 116,117. These data suggest that the presence of LR‐3/LR‐4 legions may have utility for HCC risk stratification.…”

Section: Hcc Risk‐stratification Scores and Biomarkersmentioning

confidence: 98%

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Risk stratification and early detection biomarkers for precision HCC screening

et al. 2022

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Hepatocellular carcinoma (HCC) mortality remains high primarily due to late diagnosis as a consequence of failed early detection. Professional societies recommend semi-annual HCC screening in at-risk patients with chronic liver disease to increase the likelihood of curative treatment receipt and improve survival. However, recent dynamic shift of HCC etiologies from viral to metabolic liver diseases has significantly increased the potential target population for the screening, whereas annual incidence rate has become substantially lower. Thus, with the contemporary HCC etiologies, the traditional screening approach might not be practical and cost-effective. HCC screening consists of (i) definition of rational at-risk population, and subsequent (ii) repeated application of early detection tests to the population at regular intervals. The suboptimal performance of the currently available HCC screening tests highlights an urgent need for new modalities and strategies to improve early HCC detection. In this review, we overview recent developments of clinical, molecular, and imaging-based tools to address the current challenge, and discuss conceptual framework and approaches of their clinical translation and implementation. These encouraging progresses are expected to transform the current "one-size-fits-all" HCC screening into

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Section: Imaging-based Hcc Risk Scores/ Biomarkersmentioning

confidence: 84%

Section: Hcc Risk‐stratification Scores and Biomarkersmentioning

confidence: 98%

Risk stratification and early detection biomarkers for precision HCC screening

et al. 2022

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“…[ 16 ] Onyirioha et al recently demonstrated similar variability in follow‐up among patients with LR‐4 observations. [ 34 ] Lack of standardized evaluation, compounded by short study intervals and competing risks in this population, creates a high risk of ascertainment bias, so HCC risk estimates are likely underestimated. There is a need for future prospective data among patients with LR‐3 or LR‐4 observations using a standardized protocol or CT or MRI and biopsy as needed to better characterize natural history.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of patients with Liver Imaging Reporting and Data System 3 or Liver Imaging Reporting and Data System 4 observations in patients with cirrhosis: A systematic review

et al. 2022

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Patients with indeterminate liver nodules, classified as LR-3 and LR-4 observations per the Liver Imaging Reporting and Data System, are at risk of developing hepatocellular carcinoma (HCC), but risk estimates remain imprecise. We conducted a systematic review of Ovid MEDLINE, EMBASE, and Cochrane databases from inception to December 2021 to identify cohort studies examining HCC incidence among patients with LR-3 or LR-4 observations on computed tomography (CT) or magnetic resonance imaging (MRI).Predictors of HCC were abstracted from each study, when available. Of 13 total studies, nine conducted LR-3 observation-level analyses, with the proportions of incident HCC ranging from 1.2% to 12.5% at 12 months and 4.2% to 44.4% during longer study follow-up. Among three studies with patientlevel analyses, 8%-22.2% of patients with LR-3 lesions developed LR-4 observations and 11.1%-24.5% developed HCC. Among nine studies conducting LR-4 observation-level analyses, incident HCC ranged from 30.8% to 44.0% at 12 months and 30.9% to 71.0% during study follow-up; conversely, 6%-42% of observations were downgraded to LR-3 or lower. Patient-level factors associated with HCC included older age, male sex, higher alphafetoprotein levels, viral etiology, and prior history of HCC; observation-level factors included maximum diameter, threshold growth, T2 hyperintensity, and visibility on ultrasound. Studies were limited by small sample sizes, inclusion of patients with prior HCC, short follow-up duration, and failure to account for clustering of observations in patients or competing risks of transplantation and death. LR-3 and LR-4 observations have elevated but variable risks of

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“…83 Patients with indeterminate liver nodules (LI-RADS 3 or LI-RADS 4) have an intermediate risk of HCC, between 35-65%, so typically warrant close follow-up imaging, with biopsies used in cases that would change immediate clinical management. [84][85][86] Patients without cirrhosis or high-risk HBV should undergo biopsy for histologic confirmation, as imaging features have insufficient accuracy. 49 Although a diagnosis of HCC can be made radiographically in most cases, approximately 10% of HCCs will have atypical imaging features (e.g., arterial phase hyperenhancement alone or delayed washout alone).…”

Section: Recall and Diagnosismentioning

confidence: 99%

Non-alcoholic fatty liver disease-related hepatocellular carcinoma

Daher

Dahan

Singal³

2023

JLC

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Non-alcoholic fatty liver disease (NAFLD), one of the most common causes of liver disease, is an increasingly common cause of hepatocellular carcinoma (HCC). Several demographic, clinical, and genetic factors contribute to HCC risk in NAFLD patients, which may inform risk stratification scores. Proven efficacious approaches to primary prevention approach in patients with non-viral liver disease remain an area of need. Semi-annual surveillance is associated with improved early tumor detection and reduced HCC-related mortality; however, patients with NAFLD have several challenges to effective surveillance, including under-recognition of at-risk patients, low surveillance utilization in clinical practice, and lower sensitivity of current tools for early-stage HCC detection. Treatment decisions are best made in a multidisciplinary fashion and are informed by several factors including tumor burden, liver dysfunction, performance status, and patient preferences. Although patients with NAFLD often have larger tumor burden and increased comorbidities compared to counterparts, they can achieve similar post-treatment survival with careful patient selection. Therefore, surgical therapies continue to provide a curative treatment option for patients diagnosed at an early stage. Although there has been debate about the efficacy of immune checkpoint inhibitors in patients with NAFLD, current data are insufficient to change treatment selection based on liver disease etiology.

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Clinical Outcomes of Patients With Suspicious (LI-RADS 4) Liver Observations

Cited by 13 publications

References 7 publications

Risk stratification and early detection biomarkers for precision HCC screening

Risk stratification and early detection biomarkers for precision HCC screening

Clinical outcomes of patients with Liver Imaging Reporting and Data System 3 or Liver Imaging Reporting and Data System 4 observations in patients with cirrhosis: A systematic review

Non-alcoholic fatty liver disease-related hepatocellular carcinoma

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