Fine‐needle aspiration of the liver: Out of the ivory tower and into the community

Abstract

This study of 160 consecutive fine-needle aspirates of localized hepatic masses analyzed the efficacy of the technique when extended into a multicenter setting. The aspirates were processed and interpreted by a single cytology service, but they were performed, under radiographic imaging, in eight different hospitals by at least 20 radiologists, few of whom had had the opportunity to acquire long-term experience. Of 108 malignancies, 101 were correctly sampled (sensitivity, 93.5%), including 30 primary hepatocellular carcinomas, 70 metastatic tumors, and 1 lymphoma. Specific benign pathologic lesions in 12 cases were amenable to cytodiagnosis. The problem of the remaining 47 samples, which contained exclusively blood, necrotic material, or normal and reactive hepatic constituents, was addressed at length. These were considered "nondiagnostic" samples in the context of aspirating focal masses. The majority had benign lesions on further study, but tumors were found in seven, all of which had been sampling errors, resulting in a negative predictive value of 82.5%. Fine-needle sampling of localized lesions, particularly neoplasms, can thus perform well in transition from single-center studies to more widespread usage in daily practice. Confident reliance on the procedure can be maintained if appropriate radiologic and cytologic facilities exist, provided that the limitations of nonneoplastic aspirates are fully understood.

Usefulness of a near‐total fine‐needle aspiration biopsy retrieval method: A study of its use in 85 consecutive patients

“…This view is in agreement with that of Anthony' and Hajdu and Melamed,' despite many recent reports to the contrary of the efficacy of the FNAB when used alone. '- 11 In retrospect, it is not surprising that the cytocentrifugation of formalin-and saline-washed cells is less helpful in the overall evaluation of a specimen, because this material is garnered at the end of the procedure and therefore contains fewer cells. Many other workers 4,12-15 have advocated rinsing the needle with saline in the FNAB procedure.…”

Cytologic diagnosis of cavernous hemangioma of the liver with fine‐needle biopsy

“…9,10 With recent advances in needle design and biopsy technique, finer-gauge needles (20 to 22 gauge) are now used more frequently in fine-needle aspiration biopsy l1 and core biopsy procedures, l 2 with minimal patient morbidity. 13,14 In our institution, image-guided fine-needle biopsies of the liver are performed utilizing 20-gauge Franseen needles, and the data pertaining to this experience have been previously published. l5 For the past 6 mo, in an effort to diagnose these lesions by using cytologic criteria, we have made direct smears by utilizing relatively minute fragments of tissue from fineneedle biopsy specimens and have been successful in establishing the diagnosis of CH.…”