LI-RADS与亚洲肿瘤峰会标准对小肝癌的诊断效能分析
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摘要
【目的】比较肝脏影像报告和数据管理系统LI-RADS(v2013)和亚洲肿瘤峰会AOS标准对小肝癌的诊断价值。【方法】回顾性分析有肝细胞癌发病风险的220名共289处直径≤30 mm和106名共129处直径<20 mm的肝脏病变的CT、MRI征象,分别依据LI-RADS(v2013)和AOS临床实践指南提出的影像学诊断标准,比较两者的敏感度、特异度、阳性预测值、阴性预测值及两者ROC曲线下面积(AUC值),以此评估二者的诊断价值。【结果】①直径≤30 mm者,LI-RADS(v2013)对小肝癌的敏感度、特异度、阳性预测值和阴性预测值分别为100%、67.53%、72.97%、100%,LR3-5级的阳性预测值分别为50%、73.02%、91.18%;AOS对小肝癌的敏感度、特异度、阳性预测值和阴性预测值分别为54.81%、92.21%、86.05%、70%;LI-RADS(v2013)、AOS的AUC值分别为0.83、0.74。②直径<20 mm者,LI-RADS(v2013)对小肝癌的敏感度、特异度、阳性预测值和阴性预测值分别为100%、73.56%、64.62%、100%,LR3-5级的阳性预测值分别为56.67%、83.33%、63.64%;AOS对小肝癌的敏感度、特异度、阳性预测值和阴性预测值分别为42.86%、93.10%、75%、64.80%;LI-RADS(v2013)、AOS的AUC值分别为0.87、0.68。【结论】对于直径≤30 mm和<20 mm的小肝癌,LI-RADS(v2013)的诊断价值高于AOS,其敏感度明显高于AOS、特异度较AOS略低,但LI-RADS(v2013)针对不同级别的处理原则可在一定程度上避免过度医疗。
【Objective】To discuss the diagnostic value of LI-RADS(v2013)and the criteria proposed by AOS clinical guideline for small hepatocellular carcinoma.【Methods】This retrospective trial included 289 liver lesions with diameter no more than 30 mm in 220 patients and 129 liver lesions diameter less than 20 mm in 106 patients. These patients all with chronic liver diseases had taken the examination of multi-layer spiral CT and/or high field MRI,with pathology being the golden standard,to compare the diagnostic efficiency between LI-RADS(v2013)and AOS criteria,which included sensitivity,specificity,positive predictive value,negative predictive value and their AUC values.【Results】(1) For lesions with diameter no more than 30 mm,the sensitivity,specificity,positive predictive value and negative predictive value of LI-RADS(v2013)for small hepatocellular carcinoma were 100%,67.53%,72.97%,100%,and the positive predictive value for score LR3 to LR5 in LI-RADS(v2013)were 50%,73.02% and 91.18% respectively,and the sensitivity,specificity,positive predictive value and negative predictive value of AOS criteria for small hepatocellular carcinoma were 54.81%,92.21%,86.05%,70% respectively,and the AUC value of LI-RADS(v2013)and AOS were 0.83,0.74 respectively.(2)For lesions diameter less than 20 mm,the sensitivity,specificity,positive predictive value and negative predictive value of LI-RADS(v2013)for small hepatocellular carcinoma were 100%,73.56%,64.62%,100%,and the positive predictive value for score LR3 to LR5 in LI-RADS(v2013)were 56.67%,83.33% and 63.64%respectively,and the sensitivity,specificity,positive predictive value and negative predictive value of AOS criteria for small hepatocellular carcinoma were 42.86%,93.10%,75%,64.80% respectively,and the AUC value of LI-RADS(v2013)and AOS were 0.87,0.68 respectively.【Conclusions】The diagnostic value of LI-RADS(v2013)for small hepatocellular carcinoma was higher than AOS criteria. The sensitivity of LI-RADS(v2013)was much higher than AOS,though the specificity was a little lower. However,the different treatment principles of LI-RADS(v2013)according to different scores can avoid excessive medical care,which can to a certain extent avoid the bad effect of its relatively lower specificity.
【Objective】To discuss the diagnostic value of LI-RADS(v2013)and the criteria proposed by AOS clinical guideline for small hepatocellular carcinoma.【Methods】This retrospective trial included 289 liver lesions with diameter no more than 30 mm in 220 patients and 129 liver lesions diameter less than 20 mm in 106 patients. These patients all with chronic liver diseases had taken the examination of multi-layer spiral CT and/or high field MRI,with pathology being the golden standard,to compare the diagnostic efficiency between LI-RADS(v2013)and AOS criteria,which included sensitivity,specificity,positive predictive value,negative predictive value and their AUC values.【Results】(1) For lesions with diameter no more than 30 mm,the sensitivity,specificity,positive predictive value and negative predictive value of LI-RADS(v2013)for small hepatocellular carcinoma were 100%,67.53%,72.97%,100%,and the positive predictive value for score LR3 to LR5 in LI-RADS(v2013)were 50%,73.02% and 91.18% respectively,and the sensitivity,specificity,positive predictive value and negative predictive value of AOS criteria for small hepatocellular carcinoma were 54.81%,92.21%,86.05%,70% respectively,and the AUC value of LI-RADS(v2013)and AOS were 0.83,0.74 respectively.(2)For lesions diameter less than 20 mm,the sensitivity,specificity,positive predictive value and negative predictive value of LI-RADS(v2013)for small hepatocellular carcinoma were 100%,73.56%,64.62%,100%,and the positive predictive value for score LR3 to LR5 in LI-RADS(v2013)were 56.67%,83.33% and 63.64%respectively,and the sensitivity,specificity,positive predictive value and negative predictive value of AOS criteria for small hepatocellular carcinoma were 42.86%,93.10%,75%,64.80% respectively,and the AUC value of LI-RADS(v2013)and AOS were 0.87,0.68 respectively.【Conclusions】The diagnostic value of LI-RADS(v2013)for small hepatocellular carcinoma was higher than AOS criteria. The sensitivity of LI-RADS(v2013)was much higher than AOS,though the specificity was a little lower. However,the different treatment principles of LI-RADS(v2013)according to different scores can avoid excessive medical care,which can to a certain extent avoid the bad effect of its relatively lower specificity.
引文
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[16]Khalili K,Kim TK,Jang HJ,et al.Optimization of imaging diagnosis of 1-2 cm hepatocellular carcinoma:an analysis of diagnostic performance and resource utilization[J].J Hepatol,2011,54(4):723-728.
[17]Rimola J,Forner A,Tremosini S,et al.Non-invasive diagnosis of hepatocellular carcinoma≤2 cm in cirrhosis.Diagnostic accuracy assessing fat,capsule and signal intensity at dynamic MRI[J].J Hepatol,2012,56(6):1317-1323.
[18]Ojima H,Masugi Y,Tsujikawa H,et al.Early hepatocellular carcinoma with high-grade atypia in small vaguely nodular lesions[J].Cancer Sci,2016,107(4):543-550.
[19]Hope TA,Fowler KJ,Sirlin CB,et al.Hepatobiliary agents and their role in LI-RADS[J].Abdom Imaging,2015,40(3):613-625.
[20]Tang A,Cruite I,Sirlin CB.Toward a standardized system for hepatocellular carcinoma diagnosis using computed tomography and MRI[J].Expert Rev Gastroent,2014,7(3):269-279.
[2]Parente DB,Perez RM,Eiras-Araujo A,et al.MRImaging of Hypervascular Lesions in the Cirrhotic Liver:A Diagnostic Dilemma[J].Radio Graphics,2012,32(3):767-787.
[3]Bruix J,Sherman M.Management of hepatocellular carcinoma:an update[J].Hepatology,2011,53(3):1020-1022.
[4]Poon D,Anderson BO,Chen LT,et al.Management of hepatocellular carcinoma in Asia:consensus statement from the Asian Oncology Summit 2009[J].Lancet Oncol,2009,10(11):1111-1118.
[5]韩冰,祁兴顺,贾继东.亚太肝细胞癌管理临床实践指南推荐意见(2017年更新版)[J].临床肝胆病杂志,2017,33(8):1432-1434.Han B,Qi XS,Jia JD.Recommendations of the Asia-Pacific clinical practice guidelines on the management of hepatocellular carcinoma:a 2017 update[J].J Clin Hepatol,2017,33(8):1432-1434.
[6]Colli A,Fraquelli M,Casazza G,et al.Accuracy of ultrasonography,spiral CT,magnetic resonance,and alpha-fetoprotein in diagnosing hepatocellular carcinoma:a systematic review[J].Am JGastroenterol,2006,101(3):513-523.
[7]鲁雪红,张源,刘文亚.多排螺旋CT三期增强与3.0T MR多期动态增强扫描诊断肝细胞癌的价值分析[J].实用肝脏病杂志,2018,21(5):749-752.Lu XH,Zhang Y,Liu WY.Diagnostic value of3.0T multi-phase dynamic magnetic resonance enhanced scan and multi-slice spiral CT three-phase augmentation in patients with hepatocellular carcinoma[J].J Pract Hepatol,2018,21(5):749-752.
[8]刘再毅,梁长虹.肝脏影像报告和数据管理系统(LI-RADS)介绍[J].中华放射学杂志,2012,46(8):680-681.Liu ZY,Liang CH.The introduce of Liver Imaging Reporting and Data System[J].Chin J Radiol,2012,46(8):680-681.
[9]Hussain SM,Reinhold C,Mitchell DG.Cirrhosis and Lesion Characterization at MR Imaging1[J].Radio Graphics,2009,29(6):1637-1652.
[10]朱裕,陈任政,刘红宣,等.不典型小肝癌的多排螺旋CT灌注成像与病理对照分析[J].实用医技杂志,2016,23(10):1068-1070.Zhu Y,Chen RZ,Liu HX,et al.The comparison between pathology and multi-slice spiral computed tomography perfusion imaging for atypical small hepatocellular carcinoma[J].J Pract Med Techniq,2016,23(10):1068-1070.
[11]International Consensus Group for Hepatocellular Neoplasia.Pathologic diagnosis of early hepatocellular carcinoma:a report of the international consensus group for hepatocellular neoplasia[J].Hepatology,2009,49(2):658-664.
[12]张宏,张浩,刘丽,等.《2018年美国肝病学会肝细胞癌治疗指南》摘译[J].临床肝胆病杂志,2018,34(4):743-748.Zhang H,Zhang H,Liu L,et al.An excerpt of AASLD guidelines for the treatment of hepatocellular carcinoma(2018)[J].J Clin Hepatol,2018,34(4):743-748..
[13]葛宁灵,薛同春,叶胜龙.《2018年欧洲肝病学会临床实践指南:肝细胞癌的管理》解读[J].临床肝胆病杂志,2018,34(6):1187-1190.Ge NL,Xue TC,Ye SL.Interpretation of EASLClinical Practice Guidelines:Management of hepatocellular carcinoma(2018)[J].J Clin Hepatol,2018,34(6):1187-1190.
[14]Forner A,Vilana R,Ayuso C,et al.Diagnosis of hepatic nodules 20 mm or smaller in cirrhosis:Prospective validation of the noninvasive diagnostic criteria for hepatocellular carcinoma[J].Hepatology,2008,47(1):97-104.
[15]Leoni S,Piscaglia F,Golfieri R,et al.The impact of vascular and nonvascular findings on the noninvasive diagnosis of small hepatocellular carcinoma based on the EASL and AASLD criteria[J].Am JGastroenterol,2010,105(3):599-609.
[16]Khalili K,Kim TK,Jang HJ,et al.Optimization of imaging diagnosis of 1-2 cm hepatocellular carcinoma:an analysis of diagnostic performance and resource utilization[J].J Hepatol,2011,54(4):723-728.
[17]Rimola J,Forner A,Tremosini S,et al.Non-invasive diagnosis of hepatocellular carcinoma≤2 cm in cirrhosis.Diagnostic accuracy assessing fat,capsule and signal intensity at dynamic MRI[J].J Hepatol,2012,56(6):1317-1323.
[18]Ojima H,Masugi Y,Tsujikawa H,et al.Early hepatocellular carcinoma with high-grade atypia in small vaguely nodular lesions[J].Cancer Sci,2016,107(4):543-550.
[19]Hope TA,Fowler KJ,Sirlin CB,et al.Hepatobiliary agents and their role in LI-RADS[J].Abdom Imaging,2015,40(3):613-625.
[20]Tang A,Cruite I,Sirlin CB.Toward a standardized system for hepatocellular carcinoma diagnosis using computed tomography and MRI[J].Expert Rev Gastroent,2014,7(3):269-279.