LI-RADS reporting can reduce costs of liver cancer treatment

The implementation of standardized reporting for suspected hepatocellular carcinoma improved consistency and clarity, according to an article published in the Journal of the American College of Radiology (ACR).

Radiologists more frequently included data points such as lesion diameter and Couinaud segment when writing reports, providing key information that influenced surgical or treatment planning. The study was conducted by a group of researchers from Einstein College of Medicine at Montefiore Medical Center in Bronx, New York.

Accurate diagnosis of hepatocellular carcinoma (HCC) is a pressing issue for at-risk patients. Detecting HCC at an early stage is associated with greatly improved survival through increased access to therapies and transplant options. While the Liver Imaging Reporting and Data System (LI-RADS) was developed in 2011, it still lacks guidelines for real-world implementation, according to the article.

“To facilitate compliance with the ACR’s practice guidelines for reporting of liver lesions, we created a structured reporting template adopting LI-RADS version 2014 and, after training, encouraged its use in HCC imaging surveillance and diagnosis at our large, multi-site urban academic medical center,” wrote lead author and Assistant Professor of Radiology Milana Flusberg, MD, et al.

Flusberg and her co-authors reviewed over 300 radiology reports generated between September 2015 and February 2016 that described probable or definite HCC, finding a 60/40 split between reports that used the template versus reports that were in the traditional free-text format.

Rates of reporting measurements varied widely among free text reports, ranging from 94 percent that included lesion diameter to only 28.8 percent that reported threshold growth. On the other hand, nearly all of the 180 standardized reports included all eight measures included in the study. The most notable improvement was the reporting of the LI-RADS category itself, jumping from just 18.4 percent in the free text group to 98.3 percent in the templated group, according to the article.

“One contributing reason for this large discrepancy may have been that many of our radiologists were likely not using the LI-RADS algorithm at all before introduction of the template,” wrote Flusberg et al. “However, the rate of LI-RADS category reporting did not differ in the free-text report group before and after formal LI-RADS training. Therefore, the very high rate of LI-RADS category reporting in the template group compared with the free-text group can be attributed to use of the template rather than the formal LI-RADS training.”

This has big implications for liver transplants, according to the authors. Current Organ Procurement and Transplantation Network (OPTN) standards require imaging studies to be re-done by radiologists at a transplant center, where they are more likely to use a scoring system like LI-RADS than the average imaging department.

“As we have shown in our study, implementation of a dedicated structured template improves the comprehensiveness of reports and adherence to LI-RADS and might help reduce discrepancies in HCC diagnosis between readers with different levels of experience and comfort,” wrote Flusberg and colleagues. “Implementation of a structured report could increase the rate of reporting of all OPTN-required elements and perhaps in the future eliminate the need for re-interpretation and therefore decrease health care expenditure.”