Fine-Needle Aspiration Biopsy of Hepatocellular Carcinoma and Related Hepatocellular Nodular Lesions in Cirrhosis: Controversies, Challenges, and Expectations

Wee, Aileen

doi:10.4061/2011/587936

Cited by 34 publications

(37 citation statements)

References 83 publications

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“…Presence of atypical naked nuclei has been reported to be a very important criterion of HCC diagnosis [11]. Tendency to dissociation has been observed in highly well-differentiated HCC due to narrow cords [12]. In our study, the absence of atypical naked nuclei was highly in favor of regenerative nodule because it was present in 65 % of HCC nodules, and only 10 % of cirrhotic nodules showed this finding.…”

Section: Discussionsupporting

confidence: 48%

Cytologic Comparison Between Malignant and Regenerative Nodules in the Background of Cirrhosis

Geramizadeh¹,

Asadi

Tabei

2012

Hepat Mon

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BackgroundIncidence of hepatocellular carcinoma has been increased as the sixth most common cancer in the world. Improvement in imaging techniques has decreased the need for tissue confirmation in diagnosis of hepatocellular carcinoma (HCC). Meanwhile, false negative and positive cases are present. Fine needle aspiration (FNA) biopsy can be helpful to identify well-differentiated HCCs with low risk of vascular invasion and better prognosis following transplantation.ObjectivesWe conducted this study to find useful criteria for cytological differential diagnosis between nodules of well differentiated hepatocellular in the background of cirrhosis and pure cirrhotic regenerative nodules in cytology smears.Materials and Methods140 fine needle aspirations (FNA) of fresh cirrhotic hepatectomy specimens were studied (100 pure regenerative nodules and 40 HCC nodules). All slides were reviewed by two expert pathologists. The most useful criteria were selected and evaluated in 560 cytology smears stained by Pap and Wright methods.ResultsNone of the smears from cirrhotic patients showed mitosis, transgressing endothelium, eccentric nuclei, and scant cytoplasm, but thick nuclear membrane, spindle cells and abundant, thick and monotonous cytoplasm were found in many cases with cirrhosis. Large nucleoli (2 %), multiple nucleoli (6 %), increased N/C ratio (4 %), and broad cores (2 %) were found very rarely in the smears of regenerative nodules, but they were present in 50 %, 72.5 %, 87 %, and 77.5 % of HCC nodules, respectively.ConclusionsCombination of cytologic criteria can be helpful for differential diagnosis between HCC and regenerative nodules.

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Section: Discussionsupporting

confidence: 48%

Cytologic Comparison Between Malignant and Regenerative Nodules in the Background of Cirrhosis

Geramizadeh¹,

Asadi

Tabei

2012

Hepat Mon

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“…Cytologic features of FNA of HCC have been well described in primary as well as in metastatic sites . The sensitivity and specificity of percutaneous FNA biopsy for detection of liver malignancy have been reported to be around 90% (range, 67%‐100%) and 100%, respectively . This technique is especially advantageous in patients with advanced malignancies or who are poor surgical candidates.…”

Section: Discussionmentioning

confidence: 99%

Role of fine‐needle aspiration in post liver transplant patients: A clinical/cytological review

Rohra

Mir

Lin

et al. 2018

Diagnostic Cytopathology

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Background Fine‐needle aspiration (FNA) of superficial and deep‐seated lesions has been used with high sensitivity and specificity in the diagnosis of neoplastic and nonneoplastic lesions. However, literature of FNA in posttransplant patients is sparse, especially in postliver transplant. We undertook a retrospective study to evaluate the utility of FNA in the clinical management of post liver transplant patients. Methods We searched our institution's surgical/cytologic databases (November1993–February2016) to identify liver transplant cases and FNA procedures performed on allograft liver recipients. Institutional IRB approval was obtained for this study. Results 886 liver allograft recipients were reviewed, 41(5%) of which were transplanted for hepatocellular carcinoma. 62/886(7%) underwent an FNA procedure. 39males and 23females included with mean age of 58years. Mean time between transplant and FNA was 34months. 21/62(34%) were malignant neoplasms, most common malignancy was adenocarcinoma: 8cases(3lung,3pancreas,1colon,1cholangiocarcinoma)and 8cases of transplanted hepatocellular carcinoma patients had recurrence, 6 in the allograft liver and 1case each of metastasis to the iliac bone and periportal lymph node. 3cases were squamous‐cell carcinoma (2lung and 1scalp). 2cases were posttransplant lymphoproliferative disorders. 34/62(55%) cases were benign aspirates from various organs (8lung,6liver,5pancreas,4breast,3thyroid,3lymph‐nodes and 1case each of salivary gland, bile‐duct,intraabdominal,abdominal wall,and oral cavity) 0.6/62(10%) cases were inflammatory. 22cases had histologic correlation: 5true‐positives,16true‐negatives,1false‐negative (a patient with parotid mucoepidermoid carcinoma whose FNA diagnosis was sialadenitis), and no false‐positive. The sensitivity was 83% and the specificity was 100%. The positive predictive value was 100% and the negative predictive value was 94%. Conclusions This review shows that 40/62(65%) of the aspirates were benign lesions, indicating that a conservative approach is recommended in the clinical management of these patients, especially since the interval between transplant and FNA was on average 34months. FNA is a safe, minimally invasive method to follow‐up these patients.

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“…[10][11][12][13] The tumors can be well defined with pseudocapsules or show pushing infiltrative borders. 15,16 By far, most HCCs have relatively good hepatic preservation with compelling malignant profiles and classic trabecular-sinusoidal, pseudoacinar, and/or solid compact patterns. The tumor can invade the portal and hepatic veins and, rarely, bile ducts.…”

Section: Pathologic Perspectivementioning

confidence: 99%

Hepatocellular Carcinoma

Wee¹

2014

Pathology Case Reviews

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Hepatocellular carcinoma (HCC) is a heterogeneous tumor that is often but not invariably associated with cirrhosis. The tumor can be well, moderately, or poorly differentiated. At the highly well-differentiated end, the tumor has to be distinguished from other well-differentiated hepatocellular nodular lesions, and hence a diagnosis of malignancy may be challenging to establish. At the poorly differentiated end, the malignant status is obvious, but the cell origin of cancer may be unclear. There are 2 main diagnostic challenges, namely, (i) either cirrhotic or noncirrhotic liver gives rise to a range of well-differentiated hepatocellular nodular lesions from which HCC has to be distinguished for therapeutic and prognostic purposes, and (ii) the liver is a common depository for metastases, which may mimic HCC and its variants. Hepatocellular carcinoma has a spectrum of clinical manifestations. A history of chronic viral hepatitis B or C or chronic alcoholism is common. Serum α-fetoprotein is often not significantly elevated. Tumors with classic contrast-enhanced imaging features such as arterial enhancement with portal and delayed venous washout are often not subjected to preoperative tissue confirmation by fine-needle aspiration biopsy or core-needle biopsy because of risk of bleeding and needle-tract seeding. Small tissue samples of cytohistologic material pose different types of diagnostic challenges. Ancillary tests such as immunohistochemistry may be helpful.A 70-year-old Chinese man has chronic hepatitis B virus (HBV) infection and a history of resection for colonic adenocarcinoma. A radiologically diagnosed 1.8-cm-diameter liver metastasis responded to adjuvant chemotherapy. Serum α-fetoprotein (AFP) and carcinoembryonic antigen (CEA) were not elevated. Ultrasound surveillance 2 years later showed 3 lesions in the liver suggestive of being cirrhotic. Magnetic resonance imaging revealed fatty change in the largest nodule. The differential diagnosis was among hepatocellular carcinoma (HCC), hepatocellular adenoma (HCA) with fatty change, and angiomyolipoma (AML) (Fig. 1). The smaller lesions were considered dysplastic nodules. Ultrasoundguided fine-needle aspiration biopsy (FNAB) and core-needle biopsy (CNB) were performed on the largest nodule, followed eventually by segmentectomy.

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Fine-Needle Aspiration Biopsy of Hepatocellular Carcinoma and Related Hepatocellular Nodular Lesions in Cirrhosis: Controversies, Challenges, and Expectations

Cited by 34 publications

References 83 publications

Cytologic Comparison Between Malignant and Regenerative Nodules in the Background of Cirrhosis

Cytologic Comparison Between Malignant and Regenerative Nodules in the Background of Cirrhosis

Role of fine‐needle aspiration in post liver transplant patients: A clinical/cytological review

Hepatocellular Carcinoma

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