Role of FNAC in Hepatic lesions: Risk of track metastases

Abstract

Background:Liver is one of the most common site of metastases in patients with malignancy and the evaluation of space occupying lesions (SOL) of liver in patients with malignancy is important. Its important to differentiate benign from malignant to take necessary decisions.Materials and Methods:We have performed a retrospective analysis of liver SOLs for which fine needle aspiration cytology (FNAC) was done in the year 2011. Risks and benefits associated with FNAC were evaluated.Results:We analyzed 755 patients who underwent FNAC of which 524 patients had secondary metastases to liver, 148 patients had primary hepatocellular carcinoma, 14 cases were benign neoplasms and 53 were nonneoplastic conditions. Histological correlation with FNAC was available in 112 patients. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 93%, 90.9%, 98.9%, 58.8%, and 92.8%, respectively. Though there were no incidence of bleeding, two patients developed track metastases following FNAC. One was a case of Hepatocellular carcinoma and the other a case of metastatic breast cancer.Conclusion:FNAC was very much useful in our setup where most of the patients could not afford for Computer tomography (CT) scan and was useful in counseling them especially in patients with advanced malignancy where no active cancer directed therapy is required.

Ultrasound guided fine needle aspiration cytology of space occupying lesions of liver

“…19 A report of Reddy et al, has reported low PPV of 58.8%. 12 These values are contrary to the reported studies reviewed for present work. The studies of Balani et al, Bakshi et al, and Franca et al, has reported PPV of 100% due to low false positive cases.…”

“…7 The literature reviewed for present study have commented on wide discordance between clinical diagnosis and ultrasonography as necessitating the FNAC of SOL of liver that would result in the mismanagement of sizeable number of patients. The present study recorded 25 discordant diagnosis when clinical diagnosis is compared with that of USG findings which is similar to observation made by Patel et al, and Sudhakar et al 8,10 The utility of cell block of aspirates of SOL of FNAs as paraffin block for histological assessment of SOL has been quoted to be useful and worthy in the studies of Singh et al, Goel et al, Reddy et al, and Sukumaran et al 3,5,11,12 The present study made a similar observation about utility of cell block of needle aspirates to achieve tissue diagnosis for comparison with cytodiagnosis.…”

“…These too say, a few is due to grey zones and overlap cytomorphology at interpretation. [8][9][10][11][12][13] The commonest of them is to distinguish between Hepatocellular adenoma or Nodular hyperplasia from Well-differentiated HCC, Poorly differentiated HCC from that of metastatic poorly differentiated epithelial malignancies, grading of HCC and suggesting the type and site of origin of tumour for hepatic metastatic lesions. [14][15][16][17] The advantage of ultrasound guided fine needle aspiration cytology is that the areas of interest within the liver can be identified and thereby the cellular confounders can be excluded to arrive at specific diagnosis.…”

Role of ultrasound guided fine needle aspiration cytology of right hypochondrial masses

“…Findings of present study are comparable with Munnaza, Asghar C M Swamy, and Hemlatha. 6,[8][9][10] In this study, no fatal or severe complications were noted which may be attributed to complete pre-aspiration work up and careful choice of patients.…”

Role of guided Fine needle aspiration cytology in diagnosis of abdominopelvic masses

“…[15] In the present study population, no complications occurred during and after the procedure. The incidence of needle track seedling was 0.6% (one of 148 patients of HCC) in study done by Reddy et al [16] Among the 13 cases of ovarian masses, most common lesions were malignant (eight cases, 61.54%); a similar observation was made out in the study done by Sobha et al [17] (58.3%) and Pranab et al [18] (87.5%), which was different from the observation made by Sidhalingreddy and Andola. [4] In their study, benign lesions were more common and most of them were cystadenomas.…”