Imaging‐guided and nonimaging‐guided fine needle aspiration of liver lesions: Experience with 406 patients

Abstract

The aim of the present study was to determine the diagnostic accuracy of different modes of fine needle aspiration (FNA) of liver lesions. A total of 492 FNAs were performed on 406 patients in order to confirm or to rule out focal or multifocal neoplastic disease: 29% under ultrasound (US) guidance, 3% with computed tomographic (CT) guidance, 67% preoperatively, and 1% intraoperatively without imaging guidance. Based on histologic, cytologic, and clinical findings, final diagnoses were reached in 387 patients, of whom 264 had malignant liver disease and 123 had benign liver disease. Of 321 aspirations performed in patients with malignant liver disease, the cytologic findings suggested malignancy in 225 (70.1%), suspected malignancy in 25 (7.8%), and did not reveal malignancy in 71 aspirations (22.1%). Among the 123 patients with benign liver disease, the cytologic findings were reported as benign in all but two patients, who had false-positive cytologic findings. The overall sensitivity, specificity, positive, and negative predictive values for cytologic findings were 85.6, 98.4, 99.1, and 76.1%, respectively. The overall diagnostic accuracy was 89.7%. In one patient, fatal intraperitoneal bleeding due to chronic intravascular coagulation complicated the FNA procedure. We conclude that imaging-guided FNA as well as nonguided FNA for cytologic diagnosis of liver lesions are highly accurate and only rarely may be associated with a fatal complication.

Fine Needle Biopsy of Malignant Tumors of the Liver: a Retrospective Study of 624 Cases from a Single Institution Experience

“…A tremendous variety of malignant neoplasms can occur in the liver, with metastases being much more common than primary neoplasms [1][2][3][4]. Tumors from almost the entire human body can metastasize to the liver.…”

“…FNB of liver masses can be performed percutaneously or endoscopically under ultrasound or computed tomography (CT) guidance. The sensitivity and specificity of FNB for detection of liver malignancy are up to 94% and close to100%, respectively [1][2][3][4][5]. False positives are rare, and false negative diagnoses are most often the result of sampling error.…”

“…Not much literature is available during the past ten years about FNB of liver tumors. All large studies were performed more than fifteen years ago [1,4,5,7]. The landscape of pathology is constantly changing with the introduction of new disease entities, new diagnostic methods and techniques, and new tumor classification systems including soft tissue tumors, head and neck tumors and neuroendocrine neoplasms, etc [18,19] .…”

Subcutaneous tumor seeding following needle core biopsy of hepatocellular carcinoma

“…While some authors claim that needle size, number of passes, tumor size, and differ- entiation increase the risk of tumor seeding, 13 others state that true risk factors are unknown. 7 In terms of sensitivity, specificity, and positive predictive value, FNA 19,[34][35][36][37][38][39][40] has been shown to be comparable to NCB 36,38,40,41 in the diagnosis of malignant hepatic lesions. FNA is also associated with less patient morbidity, provides faster turn-around time, and is less costly.…”

The Role of Interventional Radiology in the Management of Hepatocellular Carcinoma

“…Recent studies indicated that the diagnostic value of these methods is comparable 11 . With fna, sensitivity is 67%-100%, and specificity is 98%-100% [12][13][14][15] . The sensitivity of fna depends mostly on the technique and skill of the radiologist and the cytopathologist 16 .…”