Lymph Node Adiposity and Metabolic Dysfunction-Associated Steatotic Liver Disease

Abstract

Objective: Metabolic dysfunction-associated steatotic liver disease (MASLD), previously known as the most common chronic liver disease, is soon to be the leading indication for liver transplantation; however, the diagnosis may remain occult for decades. There is a need for biomarkers that identify patients at risk for MASLD and patients at risk for disease progression to optimize patient management and outcomes. Lymph node adiposity (LNA) is a novel marker of adiposity identified within axillary lymph nodes on screening mammography. Recent studies have demonstrated a correlation between LNA and cardiometabolic disease and cardiovascular disease risk. This study aimed to investigate the association between MASLD and LNA to evaluate the potential of mammographic LNA to serve as an imaging biomarker of MASLD. Methods: We identified women with pathology-proven MASLD who had a liver biopsy and a screening mammogram within 12 months of the liver biopsy. This resulted in a sample size of 161 women for final analysis that met the inclusion criteria. We evaluated lymph node adiposity through multiple measurements of the largest axillary lymph node visualized on mammography and correlated LNA with MASLD histology. Statistical analysis using univariable and multivariable logistic regression and odds ratios was performed using R version 4.1.0 (2021), the R Foundation for Statistical Computing Platform. Results: We found a significant association between MASLD and mammographic LNA, defined as lymph node (LN) length > 16 mm (p = 0.0004) that remained significant after adjusting for clinical factors, including body mass index (BMI). We additionally found a significant association between LNA and metabolic dysfunction-associated steatohepatitis (MASH), identified via liver biopsy (p = 0.0048). Conclusions: Mammographic lymph node adiposity may serve as a helpful imaging biomarker of MASLD in women who have an elevated risk for the development of MASH.

Keywords: fatty liver; inflammation; lymph node adiposity; metabolic disorders; metabolic dysfunction; non-alcoholic fatty liver disease; obesity; steatohepatitis; steatosis.

Figure 1

Variable lymph node size and morphology on mammographic medio-lateral oblique (MLO) views of the axilla. (A) Normal axillary lymph nodes measuring 8–11 mm (dotted line) with small physiologic “fatty notch” of lucent hilar fat (circle). (B) Fat-enlarged axillary lymph nodes measuring 25–29 mm (dotted line) due to increased lucent hilar fat (circle).

Figure 2

Data collection.

Figure 3

Lymph node (LN) measurements obtained: a—LN length, b—Hilar length, c—LN width, d—hilar width.

Figure 4

Performance of lymph node adiposity for predicting steatosis. (A) LN measurements alone yielded AUC of 61.9% to 68.7%. (B) LN measurements combined with clinical variables yielded AUC of 80.4% to 83.5%.