J Liver Cancer.  2020 Sep;20(2):120-127. 10.17998/jlc.20.2.120.

Validation of the Korean Liver Cancer Association-National Cancer Center 2018 Criteria for the Noninvasive Diagnosis of Hepatocellular Carcinoma Using Magnetic Resonance Imaging

• Lee S
• Kim MJ

• KMID: 2508023
• DOI: http://doi.org/10.17998/jlc.20.2.120

Abstract

Background/Aims
This study aimed to assess the validity and diagnostic performance of the imaging criteria of Korean Liver Cancer Association-National Cancer Center (KLCA-NCC) 2018 using magnetic resonance imaging (MRI) in high-risk patients for HCC.
Methods
This retrospective study included 142 treatment-naïve patients (81 patients who underwent MRI with extracellular contrast agent and 61 who underwent MRI with hepatobiliary agent; 183 lesions including 149 HCCs) with a high risk of HCC who underwent multiphasic contrast-enhanced MRI from January to December 2015. All lesions were categorized according to the KLCA-NCC 2018 imaging diagnostic criteria by two readers, and per-lesion diagnostic performances were compared.
Results
According to the KLCA-NCC 2018, none (0%) of the 13 benign category lesions, 11 (44.0%) of 25 indeterminate category lesions, 15 (93.8%) of 16 probable HCC category lesions, and 97 (99.0%) of 98 definite HCC category lesions were ultimately diagnosed as HCCs. The sensitivity and specificity of definite HCC category were 65.1% and 97.1%, respectively, and those of the combination of definite and probable HCC categories were 75.2% and 94.1%, respectively. The sensitivity of the combination of definite and probable HCC categories was significantly higher than that of definite HCC (P<0.001), but the specificity was not significantly lower (P>0.999).
Conclusions
The noninvasive imaging diagnosis of KLCA-NCC 2018 on MRI is reliable and useful for diagnosing HCC in high-risk patients. Combining definite and probable HCC categories of KLCA-NCC 2018 improves the sensitivity while maintaining a high specificity.

Keyword

Hepatocellular carcinoma; Diagnosis; Sensitivity and specificity; Magnetic resonance imaging

Figure

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  Figure 1 Hepatocellular carcinoma (HCC) in a 50-year-old man with chronic hepatitis B. In the arterial (A), portal venous (B), and delayed phase (C) images after the administration of extracellular contrast agent, a 47-mm liver mass (arrows) shows arterial phase hyperenhancement with washout in the delayed phase. The mass was categorized as definite HCC according to the Korean Liver Cancer Association-National Cancer Center 2018 criteria.

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  Figure 2 Hepatocellular carcinoma (HCC) in a 42-year-old woman with chronic hepatitis B. In the arterial (A), portal venous (B), and hepatobiliary phase (C) images after the administration of hepatobiliary agent, a 54-mm liver mass (arrows) shows arterial phase hyperenhancement with washout in the portal venous and hepatobiliary phases. The mass was categorized as definite HCC according to the Korean Liver Cancer Association-National Cancer Center 2018 criteria.

• 

  Figure 3 Hepatocellular carcinoma (HCC) in a 57-year-old man with chronic hepatitis B. In the arterial (A) and hepatobiliary phase (B) images after the administration of hepatobiliary agent, a 50-mm liver mass (arrows) shows washout in the hepatobiliary phase without arterial phase hyperenhancement. Non-enhancing capsule is seen. On T2-weighted image (C), the mass demonstrates mild-to-moderate T2 hyperintensity. The mass was categorized as probable HCC according to the Korean Liver Cancer Association-National Cancer Center 2018 criteria.

Reference

1. El-Serag HB. Hepatocellular carcinoma. N Engl J Med. 2011; 365:1118–1127.

2. Marrero JA, Kulik LM, Sirlin CB, Zhu AX, Finn RS, Abecassis MM, 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.

3. European Association for the Study of the Liver. European Association for the Study of the EASL Clinical Practice Guidelines: management of hepatocellular carcinoma. J Hepatol. 2018; 69:182–236.

4. Lee S, Kim MJ, Kim SS, Shin H, Kim DY, Choi JY, et al. Retrospective comparison of EASL 2018 and LI-RADS 2018 for the noninvasive diagnosis of hepatocellular carcinoma using magnetic resonance imaging. Hepatol Int. 2020; 14:70–79.

5. Korean Liver Cancer Study Group, National Cancer Center Korea. 2014 KLCSG-NCC Korea practice guideline for the management of hepatocellular carcinoma. Gut Liver. 2015; 9:267–317.

6. Korean Liver Cancer Association; National Cancer Center. 2018 Korean Liver Cancer Association-National Cancer Center Korea Practice Guidelines for the Management of Hepatocellular Carcinoma. Gut Liver. 2019; 13:227–299.

7. Kim TH, Kim SY, Tang A, Lee JM. Comparison of international guidelines for noninvasive diagnosis of hepatocellular carcinoma: 2018 update. Clin Mol Hepatol. 2019; 25:245–263.

8. Korean Liver Cancer Association; National Cancer Center. 2018 Korean Liver Cancer Association-National Cancer Center Korea Practice Guidelines for the Management of Hepatocellular Carcinoma. Korean J Radiol. 2019; 20:1042–1113.