Is concurrent LR-5 associated with a higher rate of hepatocellular carcinoma in LR-3 or LR-4 observations? An individual participant data meta-analysis. Journal Articles uri icon

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abstract

  • BACKGROUND: The Liver Imaging Reporting and Data System (LI-RADS) does not consider factors extrinsic to the observation of interest, such as concurrent LR-5 observations. PURPOSE: To evaluate whether the presence of a concurrent LR-5 observation is associated with a difference in the probability that LR-3 or LR-4 observations represent hepatocellular carcinoma (HCC) through an individual participant data (IPD) meta-analysis. METHODS: Multiple databases were searched from 1/2014 to 2/2023 for studies evaluating the diagnostic accuracy of CT/MRI for HCC using LI-RADS v2014/2017/2018. The search strategy, study selection, and data collection process can be found at https://osf.io/rpg8x . Using a generalized linear mixed model (GLMM), IPD were pooled across studies and modeled simultaneously with a one-stage meta-analysis approach to estimate positive predictive value (PPV) of LR-3 and LR-4 observations without and with concurrent LR-5 for the diagnosis of HCC. Risk of bias was assessed using a composite reference standard and Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2). RESULTS: Twenty-nine studies comprising 2591 observations in 1456 patients (mean age 59 years, 1083 [74%] male) were included. 587/1960 (29.9%) LR-3 observations in 1009 patients had concurrent LR-5. The PPV for LR-3 observations with concurrent LR-5 was not significantly different from the PPV without LR-5 (45.4% vs 37.1%, p = 0.63). 264/631 (41.8%) LR-4 observations in 447 patients had concurrent LR-5. The PPV for LR-4 observations with concurrent LR-5 was not significantly different from LR-4 observations without concurrent LR-5 (88.6% vs 69.5%, p = 0.08). A sensitivity analysis for low-risk of bias studies (n = 9) did not differ from the primary analysis. CONCLUSION: The presence of concurrent LR-5 was not significantly associated with differences in PPV for HCC in LR-3 or LR-4 observations, supporting the current LI-RADS paradigm, wherein the presence of synchronous LR-5 may not alter the categorization of LR-3 and LR-4 observations.

authors

  • Abedrabbo, Nicole
  • Lerner, Emily
  • Lam, Eric
  • Kadi, Diana
  • Dawit, Haben
  • Van Der Pol, Christian Balth
  • Salameh, Jean-Paul
  • Naringrekar, Haresh
  • Adamo, Robert
  • Alabousi, Mostafa
  • Levis, Brooke
  • Tang, An
  • Alhasan, Ayman
  • Arvind, Ashwini
  • Singal, Amit
  • Allen, Brian
  • Bartnik, Krzysztof
  • Podgórska, Joanna
  • Furlan, Alessandro
  • Cannella, Roberto
  • Dioguardi Burgio, Marco
  • Cerny, Milena
  • Choi, Sang Hyun
  • Clarke, Christopher
  • Jing, Xiang
  • Kierans, Andrea
  • Ronot, Maxime
  • Rosiak, Grzegorz
  • Jiang, Hanyu
  • Song, Ji Soo
  • Reiner, Caecilia C
  • Joo, Ijin
  • Kwon, Heejin
  • Wang, Wentao
  • Rao, Sheng-Xiang
  • Diaz Telli, Federico
  • Piñero, Federico
  • Seo, Nieun
  • Kang, Hyo-Jin
  • Wang, Jin
  • Min, Ji Hye
  • Costa, Andreu
  • McInnes, Matthew
  • Bashir, Mustafa

publication date

  • September 27, 2024