Diagnostic performance of ultrasonography-guided core-needle biopsy according to MRI LI-RADS diagnostic categories

• Published in: Ultrasonography (Seoul, Korea) 2021, 40(3), , pp.387-397
• Main Authors: Kim, Dong Wook, Kim, So Yeon, Kang, Hyo Jeong, Kang, Ji Hun, Lee, Seung Soo, Shim, Ju Hyun, Choi, Sang Hyun, Shin, Yong Moon, Byun, Jae Ho
• Format: Article
• Language: English
• Subjects: Abdomen; Biopsy; carcinoma, hepatocellular; Cholangiocarcinoma; Electronic health records; Hepatitis; image-guided biopsy; Laboratories; liver; Liver cancer; Magnetic resonance imaging; Medical records; Metastasis; Original; Pathology; Surgery; Tumors; Ultrasonic imaging; 방사선과학
• ISSN: 2288-5919; 2288-5943
• DOI: 10.14366/usg.20110

According to the American Association for the Study of Liver Diseases (AASLD) guidelines, biopsy is a diagnostic option for focal hepatic lesions depending on the Liver Imaging Reporting and Data System (LI-RADS) category. We evaluated the diagnostic performance of ultrasonography-guided core-needle biopsy (CNB) according to LI-RADS categories. High-risk patients for hepatocellular carcinoma (HCC) who underwent magnetic resonance imaging (MRI) followed by CNB for a focal hepatic lesion preoperatively were retrospectively enrolled. Focal hepatic lesions on MRI were evaluated according to LI-RADS version 2018. Pathologic results were categorized into HCC, non-HCC malignancies, and benignity. The categorization was defined as correct when the CNB pathology and surgical pathology reports were identical. Nondiagnostic results were defined as inadequate CNB pathology findings for a specific diagnosis. The proportion of correct categorizations was calculated for each LI-RADS category, excluding nondiagnostic results. After excluding 16 nondiagnostic results, 131 lesions were analyzed (45 LR-5, 24 LR-4, 4 LR-3, and 58 LR-M). All LR-5 lesions were HCC, and CNB correctly categorized 97.8% (44/45) of LR-5 lesions. CNB correctly categorized all 24 LR-4 lesions, 16.7% (4/24) of which were non-HCC malignancies. All LR-M lesions were malignant, and 62.1% (36/58) were non-HCC malignancies. CNB correctly categorized 93.1% (54/58) of LR-M lesions, and 12.5% (3/24) of lesions with CNB results of HCC were confirmed as non-HCC malignancies. In agreement with AASLD guidelines, CNB could be helpful for LR-4 lesions, but is unnecessary for LR-5 lesions. In LR-M lesions, CNB results of HCC did not exclude non-HCC malignancy.