Combined cytological and histological diagnosis of hepatocellular carcinoma in ultrasonically guided fine needle biopsy specimens

Abstract

This study evaluates the usefulness of a combined cytological and histological approach to the diagnosis of hepatocellular carcinoma (HCC) when applied to fine needle biopsy specimens obtained under ultrasonic guidance. The material, aspirated from 51 focal liver lesions, was handled in such a way that there was sufficient material for both cytological and histological (cell block) assessment. Of the 29 cases of HCC studied, a confident cytological diagnosis was made in 23 (79%). In the remaining six cases, the cytological features were considered to be suspicious but not diagnostic of HCC. Examination of cell blocks in the six cases enabled a confident diagnosis of HCC to be made in all cases. This was due to the supplementary visual information provided by the histological features, particularly the pattern of arrangement of the tumour cells.

Fine Needle Aspiration Cytodiagnosis of Liver Tumors

“…A normal reticulin pattern was found in all benign lesions. Zainol and Sumithran reported an increase in sensitivity from 79% to 100% with use of a cell block for architectural assessment, 20 and this has been supported by other studies. 12,15,19,21,23 Our laboratory processed all FNAs for both cytologic and cell block histologic study routinely, and we have found the cell block to be very useful for histologic confirmation; thus, we rarely required a second liver core biopsy for a definitive diagnosis.…”

“…9,15 The various cytomorphologic criteria most frequently used for resolving such diagnostic dilemmas include highly cellular smears; trabecular growth with a tendency for cell dissociation; nuclear atypia; increased nuclear/cytoplasm ratio; bile production; multinucleated tumor giant cells; atypical, stripped nuclei; monotonous atypia of lesional cells, including macronucleoli; welldefined granular cytoplasm; and absence of bile duct epithelium. 12,[16][17][18][19][20] None are entirely specific, and they are never useful diagnostic features because of overlap with other tumors. 21 HCC is characterized not only by the characteristic cells but also by its trabecular pattern with sinusoidal stroma, which is consistently present except in the very rare variants, such as scirrhous and fibrolamillar type.…”

Fine Needle Aspiration Biopsy of Hepatocellular Carcinoma Resembling Neuroendocrine Tumor

“…3,4,7,9,10,[12][13][14][16][17][18] The combined analysis of cytologic and histologic preparations in fine needle aspiration (FNA) biopsy diagnosis increases the sensitivity and overall accuracy of the technique. 6,16,19 A combined cytologic and histologic approach is useful with both very well and very poorly differentiated HCC as well as with its unusual features. In fact, paraffin-embedded samples from FNA biopsy give additional information about tissue architecture and provide sections for special stains and immunohistochemical analysis, whenever necessary.…”

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

“…Boer et al [6] suggested that FNA cytodiagnosis of well-differentiated HCC should pay close attention to the architectural features and reticulin stain in both smears and cell blocks. The reticular pattern is an important criterion in diagnosing malignancy [7,8] . Without cell block and reticulin stain, the reticular pattern in aspiration cytological smear is hard to identify.…”