*Purpose: The current standard of diagnosis of hepatocellular carcinoma (HCC) relies on non-invasive radiographic methods, namely computerized tomography (CT) and/or magnetic resonance imaging (MRI). However, independent studies conducted in Missouri, Belgium, and South Korea have suggested radiology may be insufficient as a stand-alone diagnosis method for HCC. Hence, we investigated the effectiveness of current diagnosis standards of HCC at MedStar Georgetown University Hospital (MGUH).

*Methods: We analyzed 130 patients who underwent liver biopsy (n=40), partial hepatectomy (n=28), or liver explant (n=62) at MGUH from December 2017 to June 2019 with a corresponding in-house radiologic study. We compared the pathology reports with their corresponding radiology reports to determine MGUH’s effectiveness in detecting HCC based on the current Liver-Imaging Reporting and Data System version 2018 (LI-RADS v2018).

*Results: Of the 130 cases analyzed, 118 cases were histologically confirmed HCC, of which 100 were correctly identified on radiology (100/118; 84.7%). The remaining 18 cases of confirmed HCC showed discrepancy with the radiology reports, to include 6 benign (6/18; 33%) and 12 non-HCC neoplasms (12/18; 67%), such as cholangiocarcinoma, lymphoma, and sarcoma, with a total discrepancy rate of 15.3% (18/118). In the residual 12 of 130 cases, 7 were histologically confirmed to be benign (completely normal or bile duct adenoma), of which 5 cases (5/7; 71.4%) were misdiagnosed as HCC by radiology. Our results revealed an overall radiology negative predictive value of 21.7% and a positive predictive value of 93.5% for HCC diagnosis.

*Conclusions: Our study provides supporting evidence, in conjunction with several of its contemporary studies, that the current LI-RADS v2018 guidelines require a further amendment to include histologic confirmation of the HCC diagnosis.

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