Imagining Alone May Not Accurately Diagnose Liver Cancer

Through physical evaluation, biphenotypic primary liver carcinoma could be misclassified.

A recent study found that the evaluation of major features of a tumor without pathological proof could potentially cause the misclassification of liver cancer.

Researchers discovered that if classification is based on imaging features alone, biphenotypic primary liver carcinoma can be misclassified as hepatocellular carcinoma (HCC).

“Most of these malignancies have at least 1 ancillary feature that may allow them to be correctly classified as a non-HCC malignancy,” said study lead author Theodora A. Potretzke, MD. “The results of our study support the importance of a more comprehensive algorithm for liver lesion assessment, such as Liver Imaging Reporting and Data Systems (LI-RADS).”

In the study, which was published by the American Journal of Roentgenology, researchers reviewed pathologically proven cases of biphenotypic primary liver carcinoma treated between 2006 and 2014 at the Mallinckrodt Institute of Radiology. Researchers found that LI-RADS provided more accurate classifications compared with classifying the tumors based on major features alone.

LI-RADS includes ancillary features, such as peripheral arterial phase hyperenhancement, and may lead to an increased accuracy, according to the study. Researchers also discovered that 54.1% of the tumors met the criteria for HCC based on major features, and could have been misclassified if it was not pathologically proven.

“Our study provided valuable information regarding the frequency of major and ancillary features of biphenotypic primary liver carcinoma,” Dr Potretzke concluded. “That a substantial percentage of lesions met strictly applied major feature criteria for HCC raises concern that the use of imaging algorithms that do not account for ancillary features may lead to misdiagnosis in some instances.”