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DOI: 10.1055/a-1309-1568
Diagnostic Accuracy of Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System (CEUS LI-RADS) for Differentiating Between Hepatocellular Carcinoma and Other Hepatic Malignancies in High-Risk Patients: A Meta-Analysis
Diagnostische Genauigkeit des Berichts- und Datensystems CEUS-LI-RADS (Contrast-Enhanced Ultrasound Liver Imaging Reporting and Data System) zur Differenzierung zwischen hepatozellulärem Karzinom und anderen malignen Lebererkrankungen bei Hochrisikopatienten: Eine Metaanalyse Gefördert durch: National Natural Science Foundation of China No. 81701702Gefördert durch: Post-Doctor Research Project, West China Hospital, Sichuan University NO. 2018HXBH073
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Abstract
Objectives The American College of Radiology (ACR) contrast-enhanced ultrasound liver imaging reporting and data system (CEUS LI-RADS), which includes diagnostic criteria for hepatocellular carcinoma (HCC) and other hepatic malignancies (OM), is increasingly used in clinical practice. This study performed a meta-analysis to assess the diagnostic accuracy of CEUS LI-RADS for differentiating between HCC and OM in high-risk patients.
Methods PubMed, Embase (Ovid), and Cochrane (CENTRAL) were searched for relevant studies. All studies that reported the percentage of HCC and OM in the LI-RADS categories were included. Random-effects models were used to calculate the pooled sensitivity and specificity, diagnostic odds ratio (DOR), and summary receiver operating characteristic (SROC) curve.
Results Eight studies involving 4215 focal liver lesions were included in the final analysis. The pooled sensitivity and specificity of the LR-5 criteria for HCC were 0.71 (95 % CI, 0.69–0.72) and 0.88 (0.85–0.91), respectively, the DOR was 18.36 (7.41–45.52), and the area under the SROC curve (AUC) was 0.8128. The pooled sensitivity and specificity of the LR-M criteria for OMs were 0.85 (0.81–0.88) and 0.86 (0.85–0.87), the DOR was 27.82 (11.83–65.40), respectively, and the SROC AUC was 0.9098.
Conclusion The CEUS LI-RADS can effectively distinguish HCC from other hepatic malignancy in high-risk patients based on LR-5 criteria and LR-M criteria. However, further studies are needed for validation due to the limited number of included studies and the potential heterogeneity among the included studies.
Zusammenfassung
Ziel Das kontrastverstärkte Ultraschall-Berichts- und Datensystem für die Leberbildgebung (CEUS-LI-RADS) des American College of Radiology (ACR), das diagnostische Kriterien für das hepatozelluläre Karzinom (HCC) und maligne Lebererkrankungen (OM) beinhaltet, wird in der klinischen Praxis zunehmend eingesetzt. Diese Studie führte eine Metaanalyse durch, um die diagnostische Genauigkeit von CEUS-LI-RADS zur Differenzierung zwischen HCC und OM bei Hochrisikopatienten zu beurteilen.
Methoden PubMed, Embase (Ovid) und Cochrane (CENTRAL) wurden nach relevanten Studien durchsucht. Einbezogen wurden alle Studien, in denen der Prozentsatz von HCC und OM in den LI-RADS-Kategorien angegeben wurde. Random-effect-Modelle wurden verwendet, um die gepoolte Sensitivität und Spezifität, die diagnostische Odds Ratio (DOR) und die summierte Receiver-Operating-Characteristic (SROC)-Kurve zu berechnen.
Ergebnisse Acht Studien mit 4215 fokalen Leberläsionen wurden in die abschließende Analyse einbezogen. Die gepoolte Sensitivität der LR-5-Kriterien für das HCC betrug 0,71 (95 %-KI 0,69–0,72) und die gepoolte Spezifität 0,88 (0,85–0,91), die DOR 18,36 (7,41–45,52) und die AUC (Area Under the Curve) der SROC 0,8128. Die gepoolte Sensitivität der LR-M-Kriterien für OMs betrug 0,85 (0,81–0,88) und die gepoolte Spezifität 0,86 (0,85–0,87), die DOR 27,82 (11,83–65,40) und die SROC-AUC 0,9098.
Schlussfolgerung CEUS-LI-RADS kann ein HCC anhand von LR-5-Kriterien und LR-M-Kriterien wirksam von anderen malignen Lebererkrankungen bei Hochrisikopatienten unterscheiden. Aufgrund der begrenzten Anzahl der eingeschlossenen Studien und deren potenzieller Heterogenität sind jedoch weitere Studien zur Validierung erforderlich.
Key words
contrast-enhanced ultrasound (CEUS) - liver - liver imaging reporting and data system (LI-RADS) - hepatocellular carcinoma (HCC)Publikationsverlauf
Eingereicht: 29. April 2020
Angenommen: 03. November 2020
Artikel online veröffentlicht:
11. Dezember 2020
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References
- 1 Torre LA, Bray F, Siegel RL. et al. Global cancer statistics, 2012. CA Cancer J Clin 2015; 65: 87-108
- 2 Llovet JM, Burroughs A, Bruix J. Hepatocellular carcinoma. Lancet 2013; 362: 1907-1917
- 3 Anstee QM, Reeves HL, Kotsiliti E. et al. From NASH to HCC: current concepts and future challenges. Nat Rev Gastroenterol Hepatol 2019; 16: 411-428
- 4 European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. Journal of Hepatology 2018; 69: 182-236
- 5 Marrero JA, Kulik LM, Sirlin CB. et al. Diagnosis, Staging, and Management of Hepatocellular Carcinoma: 2018 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology 2018; 68: 723-750
- 6 Sapisochin G, Fidelman N, Roberts JP. et al. Mixed hepatocellular cholangiocarcinoma and intrahepatic cholangiocarcinoma in patients undergoing transplantation for hepatocellular carcinoma. Liver Transpl 2011; 17: 934-942
- 7 Bohle W, Clemens PU, Heubach T. et al. Contrast-enhanced ultrasound (CEUS) for differentiating between hepatocellular and cholangiocellular carcinoma. Ultraschall in Med 2012; 33: E191-E195
- 8 Wildner D, Bernatik T, Greis C. et al. CEUS in hepatocellular carcinoma and intrahepatic cholangiocellular carcinoma in 320 patients-early or late washout matters: a subanalysis of the DEGUM multicenter trial. Ultraschall in Med 2015; 36: 132-139
- 9 Liu GJ, Wang W, Lu MD. et al. Contrast-enhanced ultrasound for the characterization of hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Liver Cancer 2015; 4: 241-252
- 10 CEUS LI-RADS® v2017. Available via https://www.acr.org/Clinical-Resources/Reporting-and-Data-Systems/LI-RADS/CEUS-LI-RADS-v2017
- 11 Chen LD, Ruan SM, Lin Y. et al. Comparison between M-score and LR-M in the reporting system of contrast-enhanced ultrasound LI-RADS. Eur Radiol 2019; 29: 4249-4257
- 12 Li F, Li Q, Liu YB. et al. Distinguishing intrahepatic cholangiocarcinoma from hepatocellular carcinoma in patients with and without risks: the evaluation of the LR-M criteria of contrast-enhanced ultrasound liver imaging reporting and data system version 2017. Eur Radiol 2020; 30: 461-470
- 13 Schellhaas B, Görtz RS, Pfeifer L. et al. Diagnostic accuracy of contrast-enhanced ultrasound for the differential diagnosis of hepatocellular carcinoma: ESCULAP versus CEUS-LI-RADS. European Journal of Gastroenterology & Hepatology 2017; 29: 1036-1044
- 14 Terzi E, Iavarone M, Pompili M. et al. Contrast ultrasound LI-RADS LR-5 identifies hepatocellular carcinoma in cirrhosis in a multicenter restropective study of 1006 nodules. Journal of Hepatology 2018; 68: 485-492
- 15 Ling W, Wang M, Ma X. et al. The preliminary application of liver imaging reporting and data system (LI-RADS) with contrast-enhanced ultrasound (CEUS) on small hepatic nodules (≤ 2cm). J Cancer 2018; 9: 2946-2952
- 16 Li JW, Ling WW, Chen S. et al. The interreader agreement and validation of contrast-enhanced ultrasound liver imaging reporting and data system. European Journal of Radiology 2019; 120 DOI: 10.1016/j.ejrad.2019.108685.
- 17 Huang JY, Li JW, Lu Q. et al. Diagnostic accuracy of CEUS LI-RADS for the characterization of liver nodules 20 mm or smaller in patients at risk for hepatocellular carcinoma. Radiology 2020; 294: 329-339
- 18 Zheng W, Li Q, Zou XB. et al. Evaluation of Contrast-enhanced US LI-RADS version 2017: application on 2020 liver nodules in patients with hepatitis B infection. Radiology 2020; 294: 299-307
- 19 Strobel D, Seitz K, Blank W. et al. Contrast-enhanced ultrasound for the characterization of focal liver lesions diagnostic accuracy in clinical practice (DEGUM multicenter trial). Ultraschall in Med 2008; 29: 499-505
- 20 Hanna RF, Miloushev VZ, Tang A. et al. Comparative 13-year meta-analysis of the sensitivity and positive predictive value of ultrasound, CT, and MRI for detecting hepatocellular carcinoma. Abdom Radiol 2016; 41: 71-90
- 21 Schellhaas B, Hammon M, Strobel D. et al. Interobserver and intermodality agreement of standardized algorithms for non-invasive diagnosis of hepatocellular carcinoma in high-risk patients: CEUS-LI-RADS versus MRI-LI-RADS. Eur Radiol 2018; 28: 4254-4264
- 22 Schellhaas B, Pfeifer L, Kielisch C. et al. Interobserver agreement for Contrast-Enhanced Ultrasound (CEUS)-based standardized algorithms for the diagnosis of hepatocellular carcinoma in high-risk patients. Ultraschall in Med 2018; 39: 667-674
- 23 Zhang J, Yu Y, Li Y. et al. Diagnostic value of contrast-enhanced ultrasound in hepatocellular carcinoma: a meta-analysis with evidence from 1998 to 2016. Oncotarget 2017; 8: 75418-75426
- 24 Schellhaas B, Bernatik T, Bohle W. et al. Contrast-enhanced ultrasound algorithms (CEUS-LIRADS/ESCULAP) for the noninvasive diagnosis of hepatocellular carcinoma-a prospective multicenter DEGUM study. Ultraschall in Med 2020; DOI: 10.1055/a-1198-4874.
- 25 Choi BI, Lee JM, Kim TK. et al. Diagnosing borderline hepatic nodules in hepatocarcinogenesis: imaging performance. Am J Roentgenol 2015; 205: 10-21
- 26 Boozari B, Soudah B, Rifai K. et al. Grading of hypervascular hepatocellular carcinoma using late phase of contrast enhanced sonography-a prospective study. Dig Liver Dis 2011; 43: 484-490
- 27 Forner A, Vilana R, Bianchi L. et al. Lack of arterial hypervascularity at contrast-enhanced ultrasound should not define the priority for diagnostic work-up of nodules <2 cm. Journal of Hepatology 2015; 62: 150-155
- 28 Leoni S, Piscaglia F, Granito A. et al. Characterization of primary and recurrent nodules in liver cirrhosis using contrast-enhanced ultrasound: which vascular criteria should be adopted?. Ultraschall in Med 2013; 34: 280-287
- 29 Jang HJ, Kim TK, Burns PN. et al. Enhancement patterns of hepatocellular carcinoma at contrast-enhanced US: comparison with histologic differentiation. Radiology 2007; 244: 898-906