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AASLD = American Association for the Study of Liver Diseases,
OPTN = Organ Procurement and Transplantation Network.
The differential diagnosis of LR-M includes:
• More common: HCC with atypical imaging features, iCCA, cHCC-CCA
• Less common: other primary or metastatic malignancies, benign entities such as sclerosing hemangiomas and abscesses.
Elevations in circulating tumor biomarkers such as AFP and CA 19-9, if available, can also refine the differential diagnosis (see FAQs page 39).
There are no simple cutoffs for interpreting AFP or CA 19-9 levels. The “normal” values for these biomarkers are ≤ 10 ng/mL and ≤ 37 Units/mL, respectively, but interpretation of values above these levels can be challenging.
Low-level elevations have a low positive predictive value for HCC or CCA. Conversely, very high values, e.g. AFP >400 ng/mL, provide high specificity but low sensitivity. Often, the trend over time is more helpful than a one-time value. For example, a rise in the AFP level from 20 to 60 ng/mL is suggestive of HCC, whereas a one-time value of 60 ng/mL is not as informative.
Another challenge is the limited knowledge of how well these biomarkers differentiate cHCC-CCA from HCC or iCCA. Interpretation of biomarker elevations can also be difficult if a patients has lesions with different imaging appearances, as it is possible to have synchronous cancers.
Targetoid → Also Metastases, but are extremely rare in cirrhotic livers.
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I am not sure if my patient has cirrhosis. Can I apply CT/MRI LI-RADS?
You can apply LI-RADS and provide a conditional category. For example: “25 mm mass with APHE and washout appearance. If the patient has cirrhosis or chronic hepatitis B, this meets criteria for LR- 5 (definitely HCC).”
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