A recent study of a patient population at an urban safety net hospital, showed that patients who had hepatitis B, and those who attend hepatology clinics, were more likely to adhere to follow-up recommendations for hepatocellular carcinoma (HCC) surveillance defined in the US Liver Imaging Reporting and Data System (US LI-RADS).
Choi
US LI-RADS offers a reporting framework for US screening and surveillance in patients at risk for developing HCC, such as those who suffer from chronic hepatitis B virus (HBV) infection and those with cirrhosis of the liver from any cause.
Because ongoing HCC surveillance guidelines can help clinicians monitor disease progression, and to ensure patients receive timely interventions, it is important to evaluate and understand factors that affect follow-up adherence.
"When we implemented US LI-RADS at our institution, we had a discussion between our radiology and hepatology departments to fine tune the guidelines to our urban, safety net health care system," said Hailey Choi, MD, assistant professor of clinical radiology in the Department of Radiology and Biomedical Imaging at the University of San Francisco (UCSF) and Zuckerberg San Francisco General Hospital. "With the clear recommendations put forth by US LI-RADS, we wondered whether they would lead to improved adherence to HCC surveillance in our patient population."
Dr. Choi and fellow researchers, including Mandana Khalili, MD, a hepatologist at UCSF, queried their institution's radiology report database and identified patients who underwent US screening between June 1, 2020, and Feb. 28, 2021. They included the initial US and first follow-up liver imaging and searched the electronic medical record for sociodemographic and clinical factors.
"We had to do some thorough chart review to collect all the socioeconomic and clinical features," said Dr. Choi, who also acknowledged the challenges the team faced in defining adherence. "For the purposes of the study, we decided to use a strict definition that specified the modality of HCC surveillance, as well as a small window for the time interval between studies."
Optimizing Adherence Requires Multipronged Approach
The study included 924 patients, mean age of 60, with a race distribution of 57.7% Asian, 15.7% white, 13.7% Hispanic, 9.7% Black and 3.1% other. More than half were male (56.7%). The researchers defined adherence to recommendations as US follow-up in six months (+/- 1) for US-1, US follow-up in three to six months for US-2, and CT/MRI in one month for US-3.
Dr. Choi reported that just 33.9% of the patients in the total population were adherent.
"Adherent patients were more likely to be female, non-English speaking, Asian, have stable housing and attend hepatology clinic," Dr. Choi said. "Adherent patients also had HBV, lower BMI, no smoking history, no substance or alcohol use and no cirrhosis."
She also noted that patients with a US LI-RADS visualization score of A, indicating optimal visibility, were more likely to be adherent.
"Despite the effort we put into reporting clear next steps for each HCC surveillance ultrasound, we found that our overall screening adherence rate remained suboptimal," Dr. Choi said, adding that lower adherence may point to factors the group did not measure. "Optimizing adherence to HCC surveillance requires a multipronged approach that considers all patient, provider and system factors including ease of surveillance methods, such as including blood-based methods that are currently under investigation."
Access the presentation, "Sociodemographic, Clinical, and Imaging Factors Associated with Adherence to US LI-RADS Recommendations in An Underserved Patient Population at An Urban Safety Net Healthcare System," on demand at Meeting.RSNA.org.
