An Imaging-Based LIE Classification for Risk Stratification of Resectability in Pediatric Abdominal Lymphatic
Suhyeon Ha1, Dae Yeon Kim1, Yu Jeong Cho2
1Department of Pediatric Surgery, Asan Medical Center, Children's Hospital, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea.
Background/Objectives:
Abdominal lymphatic malformations (ALM) in children are rare vascular anomalies with heterogeneous presentation and challenging operative anatomy. Existing classification systems are largely descriptive and provide limited guidance for predicting resectability. We developed the LIE scoring system, an imaging-based classification incorporating Location, Intestinal involvement, and Extent, to enable structured preoperative risk stratification.
Materials And Methods:
We performed a retrospective, multicenter cohort study of pediatric patients with ALM treated at eight tertiary referral centers between 2010 and 2024. Lesions were assigned LIE scores based on preoperative imaging. Scores ranged from 0 to 5, with greater weight assigned to diffuse disease. Patients were categorized as resectable (0-2), limited resectable (3), or high risk (≥4). We performed multivariable logistic regression and receiver operating characteristic (ROC) analyses.
Results:
Fifty-nine patients were included. Complete resection rates decreased with increasing score (85.7%, 66.7%, and 25%; p for trend = 0.003). Higher scores were associated with increased risk of incomplete excision (OR 5.75, 95% CI 1.04-33.13). Multivariable analysis revealed consistent associations of extent and intestinal involvement with incomplete excision. ROC analysis demonstrated modest discriminative ability (AUC 0.62). Adjunctive therapies were more frequently used in higher-score groups.
Conclusions:
The LIE scoring system provides a clinically applicable framework for preoperative risk stratification in pediatric ALM. Despite modest predictive performance, it reflects operative complexity and may support surgical planning and patient counseling.