Impact of Preoperative Fine-needle Aspiration Cytologic Examination on Clinical Outcome in Patients With Hepatocellular Carcinoma in a Tertiary Referral Center

Abstract

Hypothesis: Preoperative fine-needle aspiration cytologic examination (FNAC) exerts a statistically significant adverse effect on long-term clinical outcome in patients with hepatocellular carcinoma (HCC).

Is tumor biopsy necessary?

“…57 For lesions 10 to 20 mm 32 or > 10 to 20 mm. 27 in size, the sensitivity ranged from 65% to 96% for CT and from 89% to 92% for MRI. For liver transplantation, it is especially important that the diagnosis of HCC be correct for lesions > 20 mm because these patients receive additional MELD points to expedite transplantation in many countries.…”

“…12,13,17,[20][21][22][23][24] We identified 4 more studies. [25][26][27][28] Three of these studies were not analyzed because the reference standard was poorly defined 27,28 or some of the patients were not followed up. 25 In all, we included 1 systematic review and 9 single studies in the analysis (Tables 3 and 4).…”

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

“…The interval between detected seeding and biopsy varies from several months to 3 years. Whilst some studies have shown that preoperative FNA has no statistically adverse effect on the operability, possibility of tumor spread, or long-term survival of HCC patients [38, 39], there are others which strongly maintain that pretransplant FNA diagnosis of HCC is not necessary [40, 41]. Seeding is usually noted with subcapsular tumors and those of high-grade malignancy; these tend to be tumors >2 cm.…”

Screening for Viral Hepatitis and Hepatocellular Cancer

“…[15][16][17][18][19] Other investigators have not observed an increased risk of tumor spread. [20][21][22] Cases should be considered individually and biopsy may prove useful in cases in which imaging is not diagnostic or even in cases of large liver tumors that would be considered for transplant if the tumor grade was well differentiated. 23 In addition, concerns over sampling bias still remain.…”