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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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机构： [1]Duke University School of Medicine, Durham, NC, USA [2]The Ottawa Hospital Research Institute, Ottawa, ON, Canada [3]University of Toronto, Toronto, Canada [4]Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada [5]Thomas Jeferson University, Philadelphia, USA [6]University of Ottawa, Ottawa, Canada [7]McMaster University, Hamilton, Canada [8]Jewish General Hospital, Montreal, Canada [9]University of Montreal, Montreal, Canada [10]Taibah University, Medina, Saudi Arabia [11]The University of Texas Southwestern Medical Center, Dallas, USA [12]Division of Digestive and Liver Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA [13]Medical University of Warsaw, Warsaw, Poland [14]University of Pittsburgh, Pittsburgh, USA [15]Section of Radiology - Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy [16]Université Paris Cité, Paris, France [17]University of Ulsan, Ulsan, Republic of Korea [18]Nottingham University Hospitals NHS Trust, Nottingham, UK [19]Tianjin Third Central Hospital, Tianjin, China [20]Weill Cornell Medical Center, New York, NY, USA [21]West China Hospital of Sichuan University, Chengdu, China [22]Jeonbuk National University Medical School and Hospital, Jeonju, Republic of Korea [23]University Hospital of Zurich, Zurich, Switzerland [24]Seoul National University Hospital, Seoul, Republic of Korea [25]Dong-A University Hospital, Busan, Republic of Korea [26]Zhongshan Hospital, Fudan University, Shanghai, China [27]Images and Diagnosis Department, Universidad Austral, Buenos Aires, Argentina [28]Hepatology and Liver Transplant Unit, Universidad Austral, Buenos Aires, Argentina [29]Yonsei University Health System, Seoul, Republic of Korea [30]Sun Yat-sen University, Guangzhou, China [31]Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea [32]Queen Elizabeth II Health Sciences Centre, Halifax, Canada

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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.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.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).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.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.© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.

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大类 | 3 区医学

小类 | 3 区核医学

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第一作者机构： [1]Duke University School of Medicine, Durham, NC, USA

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