biopsy of the liver and pancreas is the evaluation of mass lesions. In the majority of FNA biopsies from both sites, an accurate diagnosis can be rendered based on cytologic features. However, in occasional cases, ancillary studies can prove quite useful in making a specific diagnosis. Although ancillary studies have a limited to nonexistent role in the FNA evaluation of most benign liver lesions, it can be quite helpful in differentiating primary liver neoplasms from metastatic malignancies. A discussion of the role of ancillary studies in the workup of both common and unusual liver malignancies will be presented. In pancreatic aspirates, ancillary studies are generally not needed for the diagnosis of the common, ductal type of pancreatic carcinoma. However, special studies such as immunocytochemistry and electron microscopy can be valuable in the workup of a variety of unusual pancreatic neoplasms as well as in the diagnosis of metastatic malignancies to the pancreas. Ancillary studies including biochemical assays for carcinoernbryonic antigen (CEA) and amylase can contribute to examination of cystic lesions of the pancreas.We recommend performance of an immediate interpretation to identify those selected cases benefiting from additional ancillary studies. I s 2 The following is a discussion of the role of ancillary studies in the FNA work of hepatic and pancreatic lesions.
LiverThe major indication for FNA of the liver is in the evaluation of a hepatic mass. 3-16 In a number of large series of hepatic aspirates, most patients have had metastatic malignancies, although some recent papers report the accuracy of FNA biopsy for the diagnosis of primary