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

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发表日期：

2024年9月27日

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

摘要

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.