한빛사논문
- 조회129
고려대학교 구로병원
Jeong Hee Yoon*, Young Kon Kim*, Jeong Woo Kim, Won Chang, Joon-Il Choi, Beom Jin Park, Jin-Young Choi, Seung-seob Kim, Hee Sun Park, Eun Sun Lee, Jeong-Sik Yu, Seong Jin Park, Myung-Won You, Chang Hee Lee**, Jeong Min Lee**
From the Department of Radiology, Seoul National University Hospital & College of Medicine, Seoul 03080, Republic of Korea (J.H.Y., J.M.L.); Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (Y.K.K.); Department of Radiology, Korea University Guro Hospital & College of Medicine, Seoul, Republic of Korea (J.W.K., C.H.L.); Department of Radiology, Seoul National University Bundang Hospital, Seongnam, Republic of Korea (W.C.); Department of Radiology, Seoul Saint Mary’s Hospital & College of Medicine, Catholic University of Korea, Seoul, Republic of Korea (J.I.C.); Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (B.J.P.); Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.Y.C., S.K.); Department of Radiology, Konkuk University School of Medicine, Seoul, Republic of Korea (H.S.P.); Department of Radiology, Chung-Ang University Hospital, Seoul, Republic of Korea (E.S.L.); Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (J.S.Y.); Department of Radiology, Kyung Hee University College of Medicine and Kyung Hee University Hospital, Seoul, Republic of Korea (S.J.P., M.W.Y.); and Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (J.M.L.).
* J.H.Y. and Y.K.K. contributed equally to this work.
** C.H.L. and J.M.L. are co-senior authors.
Address correspondence to J.M.L.
Abstract
Background
Noninvasive diagnostic guidelines for hepatocellular carcinoma (HCC) vary across different global geographic areas, especially regarding criteria about gadoxetic acid–enhanced MRI.
Purpose
To compare the diagnostic performance of four different international HCC diagnosis guidelines and readers’ judgment in diagnosing HCC using gadoxetic acid–enhanced MRI in patients at high risk for HCC.
Materials and Methods
This retrospective study included patients who had not undergone treatment, were at risk for HCC, and who underwent gadoxetic acid–enhanced MRI from January 2015 to June 2018 from 11 tertiary hospitals in South Korea. Four radiologists independently reviewed focal liver lesions (FLLs) according to four guidelines: American Association for the Study of Liver Diseases (AASLD)/Liver Imaging Reporting and Data System (LI-RADS), Korean Liver Cancer Association–National Cancer Center (KLCA-NCC), European Association for the Study of the Liver (EASL), and Asian Pacific Association for the Study of the Liver (APASL). Reader judgment (HCC or not HCC) was also recorded. Malignant FLLs were confirmed at pathology, and histologic and clinical follow-up data were used for benign FLLs. The guidelines’ diagnostic performance was compared using generalized estimating equations. Additionally, the diagnostic odds ratio was assessed.
Results
A total of 2445 FLLs (median size, 27.4 mm) were analyzed in 2237 patients (mean age, 59 years ± 11 [SD]; 1666 male patients); 69.3% (1694 of 2445) were HCCs. KLCA-NCC showed the highest accuracy (80.0%; 95% CI: 78.7, 81.2; P = .001), with high sensitivity in Eastern guidelines (APASL, 89.1% [95% CI: 87.8, 90.3]; KLCA-NCC, 78.2% [95% CI: 76.6, 79.7]) and high specificity in Western guidelines (AASLD/LI-RADS, 89.6% [95% CI: 87.8, 91.2]; EASL, 88.1% [95% CI: 86.2, 89.9]) (P = .001). The diagnostic odds ratios were 20.7 (95% CI: 17.0, 25.3) for AASLD/LI-RADS, 18.9 (95% CI: 15.8, 22.6) for KLCA-NCC, 16.8 (95% CI: 13.8, 20.4) for EASL, and 8.9 (95% CI: 7.4, 10.7) for APASL. The readers’ judgment demonstrated higher accuracy than that of the guidelines (accuracy, 86.0%; 95% CI: 84.9, 86.9; P = .001).
Conclusion
Among four different international HCC diagnosis guidelines, Eastern guidelines demonstrated higher sensitivity, whereas Western guidelines displayed higher specificity. KLCA-NCC achieved the highest accuracy, and AASLD/LI-RADS exhibited the highest diagnostic odds ratio.
논문정보
- Research article
- 2024년 04월 (BRIC 등록일 2024-05-08)
- 국내 연구진
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