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.
Abstract
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.
EDRN PI Authors
Medline Author List
- Abedrabbo N
- Adamo R
- Alabousi M
- Alhasan A
- Allen B
- Arvind A
- Bartnik K
- Bashir M
- Cannella R
- Cerny M
- Choi SH
- Clarke C
- Costa A
- Dawit H
- Diaz Telli F
- Dioguardi Burgio M
- Furlan A
- Jiang H
- Jing X
- Joo I
- Kadi D
- Kang HJ
- Kierans A
- Kwon H
- Lam E
- Lerner E
- Levis B
- McInnes M
- Min JH
- Naringrekar H
- Piñero F
- Podgórska J
- Rao SX
- Reiner CC
- Ronot M
- Rosiak G
- Salameh JP
- Seo N
- Singal A
- Song JS
- Tang A
- Wang J
- Wang W
- van der Pol C
PubMed ID
Sources
- Cancer Data Expo