Non-invasive diagnostic criteria of hepatocellular carcinoma: Comparison of diagnostic accuracy of updated LI-RADS with clinical practice guidelines of OPTN-UNOS, AASLD, NCCN, EASL-EORTC, and KLSCG-NCC

PURPOSE: To retrospectively compare the diagnostic performance of different noninvasive diagnostic criteria of HCC including LI-RADS, OPTN-UNOS, AASLD, NCCN, EASL-EORTC, KLCSG-NCC. MATERIALS AND METHODS: We reviewed the medical records of 3,491 pathologically examined liver lesions from January-2011 to January-2015 in our institution. 195 lesions in 133 patients (M:F = 100:33) with chronic hepatitis B/C and/or cirrhosis for any etiology were finally included in our study, with 98 lesions ≥ 2 cm, 72 lesions between 1–2 cm, and 25 lesions < 1 cm. The main comparison was made with the largest nodules of each patient (n = 133). The lesions were retrospectively evaluated for the diagnosis of HCC on DCE-CT or MR using different noninvasive diagnostic criteria including LI-RADS, OPTN-UNOS, AASLD, NCCN, EASL-EORTC, and KLCSG-NCC. With pathological evaluation serving as a gold-standard, sensitivity, specificity, PPV and NPV as well as accuracy of the diagnostic criteria were calculated. RESULTS: There was no statistically significant differences in diagnostic accuracy among noninvasive diagnostic criteria. For 133 lesions of the largest lesion per patient, the overall accuracy was highest with LI-RADS criteria (89.3%) and the overall sensitivity was highest with LI-RADS, AASLD, NCCN criteria (all 89.5%). For 1–2 cm lesions, sensitivity decreased for all criteria in the following order: EASL-EORTC (59.1%), KLCSG-NCC (58.3%), LI-RADS, AASLD, NCCN (all 56.5%), and OPTN-UNOS (22.7%) criteria. OPTN-UNOS had the highest specificity in cirrhotic livers, 91.7%. CONCLUSIONS: The current noninvasive diagnostic criteria of HCC have no statistically significant difference in diagnostic accuracy. Overall, LI-RADS had the highest sensitivity and accuracy among the guidelines. OPTN had the highest specificity for cirrhotic livers.