title: Validation of organ procurement and transplant network (OPTN)/united network for organ sharing (UNOS) criteria for imaging diagnosis of hepatocellular carcinoma.
abstract: BACKGROUND
  Imaging diagnosis of hepatocellular carcinoma (HCC) presents an important pathway for transplant exception points and priority for cirrhotic patients. The purpose of this retrospective study is to evaluate the validity of the new Organ Procurement and Transplant Network (OPTN) classification system on patients undergoing transplantation for HCC.
  
  
  METHODS
  One hundred twenty-nine patients underwent transplantation for HCC from April 14, 2006 to April 18, 2011; a total of 263 lesions were reported as suspicious for HCC on pretransplantation magnetic resonance imaging. Magnetic resonance imaging examinations were reviewed independently by two experienced radiologists, blinded to final pathology. Reviewers identified major imaging features and an OPTN classification was assigned to each lesion. Final proof of diagnosis was pathology on explant or necrosis along with imaging findings of ablation after transarterial chemoembolization.
  
  
  RESULTS
  Application of OPTN imaging criteria in our population resulted in high specificity for the diagnosis of HCC. Sensitivity in diagnosis of small lesions (≥1 and <2 cm) was low (range, 26%-34%). Use of the OPTN system would have resulted in different management in 17% of our population who had received automatic exception points for HCC based on preoperative imaging but would not have met criteria under the new system. Eleven percent of the patients not meeting OPTN criteria were found to have T2 stage tumor burden on pathology.
  
  
  CONCLUSIONS
  The OPTN imaging policy introduces a high level of specificity for HCC but may decrease sensitivity for small lesions. Management may be impacted in a number of patients, potentially requiring longer surveillance periods or biopsy to confirm diagnosis.
authors.affiliation: Diagnostic Radiology, Washington University, St. Louis, MO 63110, USA. fowlerk@mir.wustl.edu
authors.forename: Kathryn J
authors.initials: KJ
authors.lastname: Fowler
authors.forename: E Jane
authors.initials: EJ
authors.lastname: Karimova
authors.forename: Anthony R
authors.initials: AR
authors.lastname: Arauz
authors.forename: Nael E
authors.initials: NE
authors.lastname: Saad
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Brunt
authors.forename: William C
authors.initials: WC
authors.lastname: Chapman
authors.forename: Jay P
authors.initials: JP
authors.lastname: Heiken
mesh_terms: D000465:Algorithms; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D003952:Diagnostic Imaging / Q000379:methods; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods / Q000592:standards*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D009927:Tissue and Organ Procurement / Q000592:standards*; D016896:Treatment Outcome