Ultrasound LI-RADS: Impact of implementing a standardised reporting template for HCC surveillance
Samira Drees, Portsmouth Hospital University NHS Trust
Objectives
Outline introduction of Ultrasound Liver Imaging Reporting and Data Systems (US LI-RADS). Review the impact of introducing US LI-RADS on reporting and imaging of HCC surveillance and management of new observations in patients at risk of HCC.
Method
US LI-RADS is a standardised system for imaging technique, interpretation, reporting and data collection for surveillance ultrasound in patients at risk for developing HCC. US LI-RADS aims to improve communication, patient care, education and research by including controlled terminology, an illustrative atlas, reporting guidelines and education material. US LI-RADS is composed of categorisation of the visualisation and findings to direct further management. Quality improvement methodology was utilised to implement US LI-RADS protocols into a single NHS trust, using audits to monitor application and outcomes. Implementation of US LI-RADS was complemented through the model for improvement’s Plan-Do-Study-Act (PDSA) cycles, reviewing acceptability/barriers during implementation. Retrospective audits were conducted.
Results
Initial review of 105 ultrasound scans in 2019 demonstrated US LI-RADS reporting was correctly used 85%, with correct images recorded in 100% of examinations. Non-use was identified in non-permanent staff. 644 ultrasound reports over a 6-month period were reviewed in 2022; 45 reported abnormal findings (US2/3 scores). No US2 lesions progressed to HCC. 52.6% of US3 lesions were confirmed as cancer (42.1% as HCC, 10.5% other cancers); the remaining 47.4 % were downgraded following cross-sectional radiology (CT/MRI). Use of US LI-RADS ultrasound surveillance of US2 lesions reduced the demand on cross-sectional radiology. Using US surveillance of US2 lesions, 82% were stable on ultrasound during the review period and 18% of US2s downgraded to US1 (benign) using CT in just 1 case.
Conclusion
US LI-RADS is well accepted by the radiology team. US LI-RADS is an effective tool that creates a streamlined pathway for HCC surveillance that can correctly identify potential HCC.