A step-wise logistic regression analysis of hepatocellular carcinoma an aspiration biopsy study

Abstract

Fine needle aspiration biopsy (FNAB) has become a popular method to diagnose mass lesions of the liver. Although several reports have listed FNAB criteria to be used to diagnose both primary and metastatic tumors of the liver, none have separated key cytologic criteria from secondary criteria. We reviewed the FNAB smears from 35 patients with proven hepatocellular carcinoma and 74 patients with proven metastatic tumors in the liver. All specimens were coded as to the presence or absence of the following variables: polygonal cells with centrally placed nuclei; well-defined, granular cytoplasm; large nucleoli; small cytoplasmic vacuoles; large cytoplasmic vacuoles; bile; polymorphonuclear leukocytes; malignant cells separated by sinusoidal vessels; endothelial cells surrounding tumor cell clusters; multinucleated tumor giant cells; basophilic intracytoplasmic inclusions; eosinophilic intracytoplasmic inclusions; and intranuclear cytoplasmic inclusions. A step-wise logistic regression analysis was performed on the data to determine the variables predictive of hepatocellular carcinoma. The statistical analysis selected polygonal cells with centrally placed nuclei, malignant cells separated by sinusoidal capillaries, and bile as the key cytologic criteria for hepatocellular carcinoma. Endothelial cells surrounding tumor cell clusters and intranuclear cytoplasmic inclusions were selected as secondary criteria by this analysis.

Cytologic features and histologic correlations of microacinar and microtrabecular types of well-differentiated hepatocellular carcinoma in fine-needle aspiration biopsy

“…9 Likewise, the microacinar pattern of HCC has been reported as an acinar pattern in many cytologic studies. 6,11,13,15,27,28 In fact, nearly all the unusual cytologic features of HCC described in this study have been reported previously in the cytologic literature, including high cellularity, 7,12,13,17,29 14 and eccentric nuclei, 29 as well as the compact histologic type of HCC. 30 Pitman and Szyfelbein 15 reported that 2 of 35 cases of HCC (5.7%) failed to contain peripheral endothelium, and 1 case was well-differentiated HCC.…”

“…9 The diagnostic criteria for well-differentiated HCC in FNA cytology was described as early as 1984 10 and has been confirmed by numerous studies. [11][12][13][14][15][16][17] Welldifferentiated HCC is characterized by a hypercellular smear comprised of trabeculae of three or more cells wrapped by peripheral endothelium. We encountered an unusual type of well differentiated HCC with cytologic features that did not fulfill these diagnostic criteria yet was proven to be HCC in clinical follow-up.…”

Liver Pathology: Cirrhosis, Hepatitis, and Primary Liver Tumors. Update and Diagnostic Problems

“…Distinguishing cases of well-differentiated HCC from a regenerative nodule can pose diagnostic problems for the pathologist, especially on FNA biopsies. The literature on this subject deals mostly with lesions of moderate to poor differentiation, which are relatively straightforward (87,88). The main problems arise when the pathologist attempts to make the diagnosis on FNA biopsy material of a well-differentiated hepatocellular lesion without making and examining a cell button preparation, which would allow for architectural evaluation by hematoxylin and eosin and reticulin stains (89 -92).…”

Distinguishing well-differentiated hepatocellular carcinoma from benign liver by the physical features of fine-needle aspirates

“…In limited diagnostic samples such as needle-core tissue biopsy or fine-needle aspiration (FNA) biopsy, the diagnostic difficulties lie at both ends of the malignant spectrum, that is, the distinction of moderately to poorly differentiated hepatocellular carcinoma (HCC) from adenocarcinomas [1][2][3] and the distinction of well-differentiated HCC from cirrhosis, macroregenerative nodules, and other benign hepatic processes. [3][4][5][6][7] With the use of coordinated cytokeratins, 8,9 and Hepar-1 [10][11][12] immunostains, the problem of the former distinction is more or less solved.…”