Rapid on-Site Evaluation of Ultrasound-Guided Fine Needle Aspiration of Hepatic Masses
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- Category: Vol. 78, September 2010
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Rapid on-Site Evaluation of Ultrasound-Guided Fine Needle Aspiration of Hepatic Masses,IMAN I. RAMZY, DALIA A. OMRAN, WALEED FOUAD, HANY KHATAB and RASHA EL-ETREBY
Abstract
Background: With the advent of frequent ultrasonographic or cross-sectional imaging of the abdomen for various abdom-inal symptoms, many liver mass lesions are now discovered incidentally during imaging performed for unrelated symptoms. It is important to evaluate these incidentally discovered lesions because a significant proportion of them represent malignant or pre-malignant diseases that require appropriate management.
Objective: The purpose of this study was to evaluate the efficacy of using rapid cytological stains in diagnosis of hepatic masses, so we compared the accuracy of Fine needle aspiration cytology of focal hepatic lesions using rapid and routine cytological stains versus routine histopathology.
Patients and Methods: Thirty patients with focal hepatic lesions detected by Ultrasound and/or triphasic CT, in non cirrhotic or cirrhotic livers (child A or B patient) were included in the study.
In these cases the diagnosis of focal hepatic lesions was uncertain by imaging studies and serum tumor markers, so biopsy together with FNAC were taken.
Results: The specificity, sensitivity, positive and negative predictive value of rapid cytology as compared to histopatho-logical examination were 100%, 82.1%, 100%, and 28.6% respectively. The diagnostic accuracy was 83.3% and results were statistically significant (p-value : 0.048).
The specificity, sensitivity, positive and negative predictive value of rapid cytology as compared to routine cytological examination were 100%, 95.8%, 100%, and 85.7% respec-tively. The diagnostic accuracy was 96.6% and results were statistically significant (p-value : 0.001).
The specificity, sensitivity, positive and negative predictive value of FNAC using routine stain as compared to histopatho-logical examination were 100%, 85.7%, 100%, and 33.3% respectively. The diagnostic accuracy was 86.6% and results were statistically significant (p-value : 0.034).
The specificity, sensitivity, positive and negative predictive value of combined rapid and routine cytology as compared to histopathological examination were 100%, 85.7%, 100%, and 33.3% respectively. The diagnostic accuracy was 86.6% and results were statistically significant (p-value : 0.048).
Accurate subtyping of lesions using rapid cytology was possible in (13/28 cases) (46.4%), in which (12/21 lesions) were successfully diagnosed as HCC, while (1/5 lesions) were diagnosed as adenocarcinoma, and (0/2 lesion) was diagnosed as lymphoma with sensitivity of 57.1%, 20% and 0%, respec-tively.
Conclusion: Diagnosis of malignancy can be achieved with on-site cytologic evaluation of hepatic tumors. Specific diagnoses of hepatocellular carcinoma, and adenocarcinoma, can also be made.