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. 2022 Mar;83(2):331-343.
doi: 10.3348/jksr.2021.0173. Epub 2022 Feb 25.

LI-RADS Treatment Response versus Modified RECIST for Diagnosing Viable Hepatocellular Carcinoma after Locoregional Therapy: A Systematic Review and Meta-Analysis of Comparative Studies

Dong Hwan Kim, Bohyun Kim, Joon-Il Choi, Soon Nam Oh, Sung Eun Rha

LI-RADS Treatment Response versus Modified RECIST for Diagnosing Viable Hepatocellular Carcinoma after Locoregional Therapy: A Systematic Review and Meta-Analysis of Comparative Studies

Dong Hwan Kim et al. Taehan Yongsang Uihakhoe Chi. 2022 Mar.

Abstract
in English, Korean

Purpose: To systematically compare the performance of liver imaging reporting and data system treatment response (LR-TR) with the modified Response Evaluation Criteria in Solid Tumors (mRECIST) for diagnosing viable hepatocellular carcinoma (HCC) treated with locoregional therapy (LRT).

Materials and methods: Original studies of intra-individual comparisons between the diagnostic performance of LR-TR and mRECIST using dynamic contrast-enhanced CT or MRI were searched in MEDLINE and EMBASE, up to August 25, 2021. The reference standard for tumor viability was surgical pathology. The meta-analytic pooled sensitivity and specificity of the viable category using each criterion were calculated using a bivariate random-effects model and compared using bivariate meta-regression.

Results: For five eligible studies (430 patients with 631 treated observations), the pooled per-lesion sensitivities and specificities were 58% (95% confidence interval [CI], 45%-70%) and 93% (95% CI, 88%-96%) for the LR-TR viable category and 56% (95% CI, 42%-69%) and 86% (95% CI, 72%-94%) for the mRECIST viable category, respectively. The LR-TR viable category provided significantly higher pooled specificity (p < 0.01) than the mRECIST but comparable pooled sensitivity (p = 0.53).

Conclusion: The LR-TR algorithm demonstrated better specificity than mRECIST, without a significant difference in sensitivity for the diagnosis of pathologically viable HCC after LRT.

목적: 국소 치료 후 잔존 간세포암 진단을 위한 LI-RADS 치료 반응(liver imaging reporting and data system treatment response; 이하 LR-TR)과 modified Response Evaluation Criteria in Solid Tumors (이하 mRECIST) 기준의 진단능을 체계적으로 비교한다.

대상과 방법: MEDLINE과 EMBASE에서 역동적 조영증강 CT 또는 MRI를 이용하여 LR-TR과 mRECIST의 진단능을 개인 내 비교한 원저를 검색하였다. 생존 종양에 대한 참조 표준은 수술을 통한 병리 진단을 사용하였다. 각 기준의 생존 카테고리에 대한 메타분석적 통합 민감도와 특이도는 bivariate random-effects model을 통해 계산하였고 bivariate meta-regression을통해 비교하였다.

결과: 총 다섯 개의 포함된 연구들에서(430명 환자들 및 631개 치료된 병변들), LR-TR 생존 카테고리의 병변별 통합 민감도와 특이도는 58% (95% 신뢰구간, 45%–70%)와 93% (95% 신뢰구간, 88%–96%)이었으며 mRECIST 생존 카테고리는 56% (95% 신뢰구간, 42%–69%)와 86% (95% 신뢰구간, 72%–94%)이었다. LR-TR 생존 카테고리는 mRECIST에 비하여 유의하게 높은 특이도를 보였으나(p < 0.01) 민감도는 유사하였다(p = 0.53).

결론: LR-TR 알고리즘은 국소 치료 후 병리학적 잔존 간세포암의 진단에 대하여 민감도의 유의한 차이 없이 mRECIST보다 높은 특이도를 보였다.

Keywords: Hepatocellular Carcinoma; Meta-Analysis; Response Evaluation Criteria in Solid Tumors; Systematic Review; Treatment Outcome.

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Conflict of interest statement

Conflicts of Interest: The authors have no potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1. Flow diagram of the article selection process.
LR-TR = LI-RADS Treatment Response, LI-RADS = Liver Imaging Reporting and Data Systems, mRECIST = modified Response Evaluation Criteria in Solid Tumors
Fig. 2
Fig. 2. Coupled forest plots of sensitivity and specificity of the LI-RADS Treatment Response (A) and mRECIST viable category (B) for diagnosing viable hepatocellular carcinoma.
CI = confidence interval, LI-RADS = Liver Imaging Reporting and Data Systems, mRECIST = modified Response Evaluation Criteria in Solid Tumors
See this image and copyright information in PMC

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