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Prognosis of Single Early-Stage Hepatocellular Carcinoma (HCC) with CEUS Inconclusive Imaging (LI-RADS LR-3 and LR-4) Is No Better than Typical HCC (LR-5)

SIMPLE SUMMARY: The European (EASL) and American (AASLD) guidelines for the management of hepatocellular carcinoma (HCC) suggest different management of nodules with indeterminate imaging in cirrhosis. In particular, nodules classified as LR-3 and LR-4 by the CEUS LI-RADS algorithm (indeterminate fo...

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Autores principales: Terzi, Eleonora, Giamperoli, Alice, Iavarone, Massimo, Leoni, Simona, De Bonis, Ludovico, Granito, Alessandro, Forgione, Antonella, Tovoli, Francesco, Piscaglia, Fabio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8773738/
https://www.ncbi.nlm.nih.gov/pubmed/35053498
http://dx.doi.org/10.3390/cancers14020336
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author Terzi, Eleonora
Giamperoli, Alice
Iavarone, Massimo
Leoni, Simona
De Bonis, Ludovico
Granito, Alessandro
Forgione, Antonella
Tovoli, Francesco
Piscaglia, Fabio
author_facet Terzi, Eleonora
Giamperoli, Alice
Iavarone, Massimo
Leoni, Simona
De Bonis, Ludovico
Granito, Alessandro
Forgione, Antonella
Tovoli, Francesco
Piscaglia, Fabio
author_sort Terzi, Eleonora
collection PubMed
description SIMPLE SUMMARY: The European (EASL) and American (AASLD) guidelines for the management of hepatocellular carcinoma (HCC) suggest different management of nodules with indeterminate imaging in cirrhosis. In particular, nodules classified as LR-3 and LR-4 by the CEUS LI-RADS algorithm (indeterminate for HCC) are suggested to be biopsied according the EASL guidelines, but may be only monitored with follow-up imaging, with biopsy left to selected LR-4/LR-M cases, according to the AASLD ones. The present study shows that CEUS LI-RADS classes LR-3 and LR-4 HCC have no better clinical outcome than typical HCC (LR-5). Such data support the EASL policy, aimed at conclusive diagnostic investigations of indeterminate nodules up to obtaining histological proof to avoid leaving aggressive HCC not timely treated. ABSTRACT: The American College of Radiology (ACR) released the Liver Imaging Report and Data System (LI-RADS) scheme, which categorizes hepatic nodules in risk classes from LR-1 to LR-5 (according to the degree of risk to be HCC) and LR-M (probable malignancy not specific for HCC). The aim of this study was to test whether HCC with different LR patterns on CEUS have different overall survival (OS) and recurrence-free survival (RFS). We retrospectively enrolled 167 patients with the first definitive diagnosis of single HCC (by using CT/MRI or histological techniques if CT/MRI were inconclusive) for whom CEUS examination was available. The median size of HCC lesions was 2.2 cm (range 1.0–7.2 cm). According to CEUS LI-RADS classification, 28 patients were in LR-3, 48 in LR-4, 83 in LR-5, and 8 in LR-M. Patient liver function and nodule characteristics were not statistically different between CEUS LI-RADS classes. Using univariate analysis, CEUS LI-RADS class was not found to be a predictor of survival (p = 0.347). In conclusion, HCC showing the CEUS LI-RADS classes LR-3 and LR-4 have no better clinical outcome than typical HCC. Such data support the EASL policy, aimed at conclusive diagnostic investigations of indeterminate nodules up to obtaining histological proof to avoid leaving aggressive HCC not timely treated.
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spelling pubmed-87737382022-01-21 Prognosis of Single Early-Stage Hepatocellular Carcinoma (HCC) with CEUS Inconclusive Imaging (LI-RADS LR-3 and LR-4) Is No Better than Typical HCC (LR-5) Terzi, Eleonora Giamperoli, Alice Iavarone, Massimo Leoni, Simona De Bonis, Ludovico Granito, Alessandro Forgione, Antonella Tovoli, Francesco Piscaglia, Fabio Cancers (Basel) Article SIMPLE SUMMARY: The European (EASL) and American (AASLD) guidelines for the management of hepatocellular carcinoma (HCC) suggest different management of nodules with indeterminate imaging in cirrhosis. In particular, nodules classified as LR-3 and LR-4 by the CEUS LI-RADS algorithm (indeterminate for HCC) are suggested to be biopsied according the EASL guidelines, but may be only monitored with follow-up imaging, with biopsy left to selected LR-4/LR-M cases, according to the AASLD ones. The present study shows that CEUS LI-RADS classes LR-3 and LR-4 HCC have no better clinical outcome than typical HCC (LR-5). Such data support the EASL policy, aimed at conclusive diagnostic investigations of indeterminate nodules up to obtaining histological proof to avoid leaving aggressive HCC not timely treated. ABSTRACT: The American College of Radiology (ACR) released the Liver Imaging Report and Data System (LI-RADS) scheme, which categorizes hepatic nodules in risk classes from LR-1 to LR-5 (according to the degree of risk to be HCC) and LR-M (probable malignancy not specific for HCC). The aim of this study was to test whether HCC with different LR patterns on CEUS have different overall survival (OS) and recurrence-free survival (RFS). We retrospectively enrolled 167 patients with the first definitive diagnosis of single HCC (by using CT/MRI or histological techniques if CT/MRI were inconclusive) for whom CEUS examination was available. The median size of HCC lesions was 2.2 cm (range 1.0–7.2 cm). According to CEUS LI-RADS classification, 28 patients were in LR-3, 48 in LR-4, 83 in LR-5, and 8 in LR-M. Patient liver function and nodule characteristics were not statistically different between CEUS LI-RADS classes. Using univariate analysis, CEUS LI-RADS class was not found to be a predictor of survival (p = 0.347). In conclusion, HCC showing the CEUS LI-RADS classes LR-3 and LR-4 have no better clinical outcome than typical HCC. Such data support the EASL policy, aimed at conclusive diagnostic investigations of indeterminate nodules up to obtaining histological proof to avoid leaving aggressive HCC not timely treated. MDPI 2022-01-11 /pmc/articles/PMC8773738/ /pubmed/35053498 http://dx.doi.org/10.3390/cancers14020336 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Terzi, Eleonora
Giamperoli, Alice
Iavarone, Massimo
Leoni, Simona
De Bonis, Ludovico
Granito, Alessandro
Forgione, Antonella
Tovoli, Francesco
Piscaglia, Fabio
Prognosis of Single Early-Stage Hepatocellular Carcinoma (HCC) with CEUS Inconclusive Imaging (LI-RADS LR-3 and LR-4) Is No Better than Typical HCC (LR-5)
title Prognosis of Single Early-Stage Hepatocellular Carcinoma (HCC) with CEUS Inconclusive Imaging (LI-RADS LR-3 and LR-4) Is No Better than Typical HCC (LR-5)
title_full Prognosis of Single Early-Stage Hepatocellular Carcinoma (HCC) with CEUS Inconclusive Imaging (LI-RADS LR-3 and LR-4) Is No Better than Typical HCC (LR-5)
title_fullStr Prognosis of Single Early-Stage Hepatocellular Carcinoma (HCC) with CEUS Inconclusive Imaging (LI-RADS LR-3 and LR-4) Is No Better than Typical HCC (LR-5)
title_full_unstemmed Prognosis of Single Early-Stage Hepatocellular Carcinoma (HCC) with CEUS Inconclusive Imaging (LI-RADS LR-3 and LR-4) Is No Better than Typical HCC (LR-5)
title_short Prognosis of Single Early-Stage Hepatocellular Carcinoma (HCC) with CEUS Inconclusive Imaging (LI-RADS LR-3 and LR-4) Is No Better than Typical HCC (LR-5)
title_sort prognosis of single early-stage hepatocellular carcinoma (hcc) with ceus inconclusive imaging (li-rads lr-3 and lr-4) is no better than typical hcc (lr-5)
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8773738/
https://www.ncbi.nlm.nih.gov/pubmed/35053498
http://dx.doi.org/10.3390/cancers14020336
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