Value of ultrasonography-guided fine needle aspiration cytology in the investigative sequence of hepatic lesions with an emphasis on hepatocellular carcinoma

Abstract

Background: The evaluation and management of various hepatic lesions is a common clinical problem and their appropriate clinical management depends on accurate diagnoses.

Aims: To study the cytomorphological features of distinctive non-neoplastic and neoplastic lesions of the liver and to evaluate the sensitivity, specificity and diagnostic accuracy of ultrasonography (USG)-guided fine needle aspiration cytology (FNAC) in the diagnosis of liver diseases.

Materials and methods: Seventy-two patients with evidence of liver diseases underwent USG-guided, percutaneous FNAC. Cytomorphological diagnoses were correlated with clinical, biochemical and radiological findings, histopathological diagnoses and follow-up information.

Results: The age of the patients ranged from eight months to 90 years with 48 males (66.67%) and 24 females (33.33%). Of the 72 cases, the cytological diagnosis was rendered in 71 patients and smears were inadequate for interpretation in one case. Neoplastic lesions (68.06%) were more common than non-neoplastic lesions (30.56%). The majority of the neoplastic lesions were hepatocellular carcinomas (36.12%) followed by metastatic adenocarcinomas (19.45%). Among non-neoplastic lesions, cirrhosis was the commonest lesion (8.34%). The overall diagnostic accuracy of FNAC was 97.82% with a sensitivity and specificity of 96.87 and 100% respectively.

Conclusion: USG-guided FNAC of the liver is a safe, simple, cost-effective and accurate method for cytological diagnosis of hepatic diffuse, focal/nodular and cystic lesions with good sensitivity and specificity.

Keywords: Fine needle aspiration cytology; hepatic lesions; ultrasonography.

Figure 1

FNAC of liver: (a) Pyogenic liver abscess - polymorphonuclear leucocytes, necrotic cells and debris (MGG, ×100). (b) Amoebic liver abscess - Trophozoite of E. histolytica (arrow) on a necrotic background with inflammatory cells (MGG, ×400). (c) Cirrhosis - Reactive hepatocytes with degenerative/ regenerative features; cluster of bile ductal cells; fragment of fibrous tissue with spindle - shaped nuclei (MGG, ×100). Inset: Reactive hepatocytes adjacent to a thick fragment of fibrous tissue (MGG,×400). (d) Granulomatous hepatitis - Aggregate of epithelioid histiocytes and Langhan's giant cell (H and E, ×400)

Figure 2

FNAC of liver: (a) Hydatid cyst liver - Debris and altered blood along with many refractile hooklets of E. granulosus (arrows) (MGG, ×100). (b) WDHCC - Pseudo - acinar formation, intracytoplasmic eosinophilic inclusions and bile (MGG, ×400). Inset: Intra - nuclear inclusion (arrow) (Pap, ×400). (c) MDHCC - Discohesive pleomorphic hepatocytes centrally transgressed by a proliferating band of endothelium (Pap, ×400). (d) PDHCC - Discohesive malignant cell clusters with poorly preserved hepatocytic features, extremely high N:C ratio (H and E, ×400)

Figure 3

FNAC of liver: (a) Metastatic renal cell carcinoma - Tissue fragments with discohesive cells adhering to strands of pink stroma/basement membrane; enlarged pleomorphic nuclei; variable N:C ratio; abundant vacuolated cytoplasm (MGG, ×400). (b) Metastatic malignant melanoma - Pleomorphic cells with well - defined cytoplasm; eccentric nuclei; multinucleated cells; prominent nucleoli; dust - like pigment within the cytoplasm, macrophages in the background (MGG, ×400)