Fine Needle Aspiration Cytodiagnosis of Liver Tumors

Kuo, Fang-Ying; Chen, Wei-Jen; Lu, Sheng–Nan; Wang, Jing‐Houng; Eng, Hock‐Liew

doi:10.1159/000326307

Cited by 68 publications

(68 citation statements)

References 10 publications

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“…False positives are rare. 24 Although liver biopsy is not used as frequently for a definitive histopathological diagnosis of HCC, it has an important role in lesions with atypical features on imaging studies. The ability to discriminate between dysplastic nodules and early HCC has become increasingly important, as the efficacy of treatments for HCC, depends on recognition at an early phase.…”

Section: Is Tissue Diagnosis Required?mentioning

confidence: 99%

Tissue Diagnosis of Hepatocellular Carcinoma

Jain

2014

Journal of Clinical and Experimental Hepatology

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The current American Association for the Study of Liver Diseases (AASLD) guideline provides strategies for achieving the diagnosis of hepatocellular carcinoma (HCC) based on the size of liver nodules seen on surveillance imaging. For lesions less than 1 cm in size, follow-up surveillance imaging is recommended. Lesions larger than 2 cm require typical radiological hallmark on dynamic imaging. Lesions of 1-2 cm in size require typical imaging features including intense uptake of contrast during arterial phases followed by decreased enhancement during portal venous phases on at least 2 imaging modalities. In cases of atypical radiological features of the suspected lesion, tissue diagnosis either by fine needle aspiration or biopsy should be obtained. Although fine needle aspiration could give a smaller risk of seeding than biopsy, biopsy has been preferred over cytology. Percutaneous biopsy of HCC carries a potential risk of tumor seeding along the needle tract. However the risk is low and there is no clear evidence of post transplant recurrence due to needle tract seeding. Histopathologic assessment can differentiate between premalignant lesions such as dysplastic nodules and early HCC. Atypical variants of HCC can be recognized morphologically which may have associated prognostic value. ( J CLIN EXP HEPATOL 2014;4:S67-S73) H epatocellular carcinoma (HCC) is the sixth most common cancer in the world. 1 Its incidence is expected to rise in the future due to anticipated increase in cirrhosis secondary to viral hepatitis. Over the past 2 decades, the incidence of HCC has tripled, and hepatitis C virus (HCV) related HCC is the fastest-rising cause of cancer-related death in the United States. [2][3][4] Hepatocellular carcinoma develops within an established background of chronic liver disease in 70-90% of all patients. 5 The most frequent risk factor for HCC is chronic hepatitis B virus (HBV) infection in Asia and Africa. However HCV predominates as a risk factor in Europe and Japan. 2 Other well established risk factors are alcoholism, non-alcoholic fatty liver disease and diabetes. [6][7][8] Treatment depends on early diagnosis by screening high-risk patients when HCC is small and remains localized to the liver. Various studies suggest surveillance of HCC in cirrhotic patients irrespective of its etiology. Surveillance of non-cirrhotic patients is also advocated, especially in HBV carriers with serum viral load >10,000 copies/ml 9 or HCV infected patients with bridging fibrosis. Patients with HCV infection and advanced fibrosis remain at risk for HCC even after achieving sustained virological response following antiviral treatment.The preferred imaging method for screening is ultrasonography (USG) which is well tolerated and widely available. However, the sensitivity of USG for HCC detection is low because small nodules can be missed in a cirrhotic liver. 10 Use of contrast-enhanced USG improves the diagnostic performance of USG for HCC.The most used serological test in clinical setting for screening is alpha-fetop...

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Section: Is Tissue Diagnosis Required?mentioning

confidence: 99%

Tissue Diagnosis of Hepatocellular Carcinoma

Jain

2014

Journal of Clinical and Experimental Hepatology

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“…Special staining (in some cases) was also done to identify the nature of malignancy. It was reported that cytodiagnosis of liver tumors has good sensitivity and specificity [4] , suggesting that our final results based on the cytopathological diagnosis from our pathological department are reliable.…”

Section: Discussionmentioning

confidence: 55%

“…Fine needle aspiration (FNA) is able to get tumor specimens for cytological interpretation [1] . Ultrasound-guided FNA (US-FNA) can get a correct specimen and provide a good diagnosis of liver tumor [2][3][4] . US-FNA is a safe and effective method for cytodiagnosis of liver tumor [2][3][4] .…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Liu-stain quick cytodiagnosis of ultrasound-guided fine needle aspiration in diagnosis of liver tumors

Changchien

Wang²,

Lu³

et al. 2007

WJG

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AIM:To combine ultrasound-guided fine-needle aspiration (US-FNA) and Liu (Riu) stain to make a quick study on liver tumor lesions. METHODS:Two hundred and twenty-eight aspirations from 232 patients were completely studied. The operator himself made the quick cytodiagnosis of US-FNA smear stained by Liu method within thirty minutes. The US-FNA specimen was also sent to the pathological department for cytological study and cellblock histology. The result of our Liu-stain quick cytodiagnosis in each patient was confirmed by the final cytopathological diagnosis from pathological report. RESULTS:Among 228 samples, the quick cytodiagnosis revealed 146 malignancies, 81 benign lesions and one inadequate specimen. Cytopathological diagnosis from the pathological department revealed 150 malignancies, and 78 benign lesions. Four well-differentiated hepatocellular carcinomas (HCCs) were under-diagnosed by quick cytodiagnosis as benign and 3 benign lesions were over-diagnosed as well-differentiated HCCs. Compared with cytopathological diagnosis, quick cytodiagnosis correctly diagnosed 143 malignancies and 77 benign lesions. Except for the one inadequate specimen in quick cytodiagnosis, the accuracy of quick cytodiagnosis was 96.9% (220/227), and its sensitivity, specificity and positive and negative predictive values were 97.9%, 95.1%, 97.3% and 96.3%, respectively. CONCLUSION:Liu-stain quick cytodiagnosis is a fast, convenient, safe and effective method for hepatologists in clinic practice to diagnose liver tumor. In few cases of well-differentiated HCC, Liu-stain quick cytodiagnosis has its limitation.

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“…The cytological diagnosis is usually taken as definitive, which makes it critical for patient management (Kocjan G 2010). However, in the literature it is reported that FNA of the liver has variable diagnostic sensitivity (60-100%), and that difficulties exist in diagnosing well-differentiated HCCs and in distinguishing primary from metastatic tumors (Kuo et al, 2004;Ligato et al, 2008). For this reason, additional studies that can be performed on cytological samples are desirable to aid diagnosis.…”

Section: Simple and Universally Applicable Methods For Staining Fixed mentioning

confidence: 99%