Clinicoradiographic predictors of progression of an intermediate hepatic lesion (LI-RADS 3) to hepatocellular carcinoma (LI-RADS 5)

Aim: We sought to identify predictors of progression of an indeterminate observation (LI-RADS 3) to hepatocellular carcinoma (LI-RADS 5). Methods: Imaging reports with LI-RADS (LR) assignments were identified among patients at the University of Washington, 2013-2017. Patients with an LR3 lesion and follow-up scan within 1 year of LR3 lesion date were included (n = 313). Features of interest were abstracted from chart review. Survival analyses employing interval censoring were performed, with variables potentially predictive of LR3 progression identified in univariate analyses. Backwards elimination (P < 0.05) was used to obtain the final multivariate model. Results: 20.4% of LR3 lesions progressed to LR5; 73% remained LR3, 8% LR4. The cohort was predominantly male (61%), Caucasian (54%), older than 55 (63%). 47% had a history of hepatitis C virus (HCV), 33% with alcohol abuse, not mutually exclusive. Alpha-fetoprotein (AFP) at the time of LR3 scan was low if available (39% with AFP < 5, 29% unknown). CT was the most common exam (56%). Men (HR = 2.0, P = 0.02), earlier scan year (HR = 0.47 per year, P < 0.0001), and older age (HR = 1.48, P = 0.03), appeared as predictors of LR progression in the final model. HCV and alcohol use were more common among men but did not appear to explain the difference in LR progression by sex. Conclusion: Our analysis is an early exploration of characteristics that may predict the risk of progression of an LR3 observation to hepatocellular carcinoma. Future efforts may allow for risk stratification to identify high-risk indeterminate lesions that may benefit from earlier intervention or more frequent surveillance.