Abstract

Background: Ultrasound LI-RADS version 2017 recommends that patients with US-2 subthreshold observations undergo repeat surveillance ultrasound in 3-6 months and return to routine surveillance if the observation shows no growth for 2 years. However, outcomes of US-2 observations are unknown. Objective: To determine imaging outcomes of US-2 observations detected on surveillance ultrasound examinations. Methods: This retrospective study included 175 patients (median age, 59 years; 70 women, 105 men) at high risk for hepatocellular carcinoma (HCC) with US-2 observations (i.e., subcentimeter observations) on surveillance ultrasound. Observations were classified on =2-year follow-up ultrasound as showing no correlate, stable (if remaining subcentimeter), or progressed (if measuring =10 mm, meeting US-3 criteria). Observations were classified on follow-up multiphasic CT or MR (stratified as <2-year vs =2-year follow-up) as showing no correlate or, if showing a correlate, using CT/MRI LI-RADS version 2018. Results: A total of 111 patients had =2-year follow-up ultrasound and 106 had follow-up CT or MRI (79 before 2 years, 27 after 2 years). Based on final follow-up examinations, 173/175 observations were stable on =2-year follow-up ultrasound (n=68); showed no correlate on follow-up ultrasound, CT, or MRI (n=88); or were classified as LR-1 or LR-2 on CT or MRI (n=17). The remaining 2/175 observations were LR-3 on CT or MRI. No observations progressed to US-3 on follow-up ultrasound or were classified as =LR-4 on CT or MRI. A correlate was observed in 25 of the 106 follow-up CT or MRI examinations, (LR-1 or LR-2 in 23; LR-3 in 2). Eight patients developed HCC at a median of 2.0 years after initial US-2 observation detection; all HCCs were in separate locations from the baseline observations and were preceded by a surveillance ultrasound that could not re-identify the baseline observation. In three patients who underwent liver transplant, the explant showed no dysplastic nodule or HCC. Conclusion: US-2 subthreshold observations are unlikely to progress or become HCC and commonly have no correlate on follow-up imaging. Clinical Impact: Because of the low progression rate of US-2 subthreshold observations, it is unclear if an extended period of intensive surveillance, as recommended by multiple professional societies, is warranted.

View details for DOI 10.2214/AJR.22.27812

View details for PubMedID 35703411