Abstract
There is still debate over the relative merits of cytology and histology in diagnosing hepatocellular carcinoma in cirrhotic livers. Previous comparisons of the diagnostic accuracies of these two methods may have been biased by sampling errors due to multiple punctures. We compared the diagnostic accuracies of cytology and microhistology using tissue and cells from the same point in liver nodules subsequently proved to be hepatocellular carcinoma. A single ultrasound-guided liver-nodule biopsy was obtained with a 20- to 21-G cutting needle from 131 cirrhotic patients. The solid portion of samples was used for microhistology; the remainder was subjected to smear cytology. The results of each type of examination were expressed as true positive, nonspecific malignancy, false negative, or inadequate for diagnosis. No false-positive diagnoses were made in 13 benign lesions. In 118 HCC nodules (particularly those <30 mm in diameter), cytology provided a significantly higher percentage of correct diagnoses (85.6%) that was only slightly inferior to that based on results of both studies (89.8%). The single-biopsy technique generally provides adequate tissue for histology and cytology specimens with a high cellularity. It reduces both the cost and the risks of fine-needle biopsy diagnosis of hepatocellular carcinoma.
Similar content being viewed by others
References
Bret PM, Labadie M, Bretagnolle M, Paliard P, Valette PJ: Hepatocellular carcinoma: diagnosis by percutaneous fine needle biopsy. Gastrointest Radiol 13:253–255, 1988
Buscarini L, Fornari F, Bolondi L, Colombo P, Livraghi T, Magnolfi F, Rapaccini GL: Ultrasound-guided fine-needle biopsy of focal liver lesions: Techniques, diagnostic accuracy and complications. A retrospective study on 2091 biopsies. J Hepatol 11:344–348, 1990
Sbolli G, Fornari F, Civardi G, Di Stasi M, Cavanna L, Buscarini E, Buscarini L: Role of ultrasound guided fine needle aspiration biopsy in the diagnosis of hepatocellular carcinoma. Gut 33:1303–1305, 1990
Sangalli G, Livraghi T, Giordano F: Fine-needle biopsy: Improvement in diagnosis by microhistology. Gastroenterology 96:524–526, 1989
Atterbury CE, Enriquez RE, Detusonagy GI, Conn HO: Comparison of the histologic and cytologic diagnosis of liver biopsies in hepatic cancer. Gastroenterology 76:1352–1357, 1979
Glenthoj A, Sehested M, Torp-Pedersen S: Diagnostic reliability of histological and cytological fine-needle biopsies from focal liver lesions. Histopathology 15:375–383, 1989
Borizo M, Borzio F, Macchi R, Croce AM, Bruno S, Ferrari A, Servida E: The evaluation of fine-needle procedures for the diagnosis of focal liver lesions in cirrhosis. J Hepatol 20:117–121, 1994
Arakawa M, Kage M, Sugihara S, Nakashima T, Suenaga M, Okuda K: Emergence of malignant lesions within an adenomatous hyperplastic nodule in a cirrhotic liver: Observations in five cases. Gastroenterology 91:198–208, 1986
Takayama T, Makuuchi M, Hirohashi S, Sakamoto M, Okazaki N, Takayasu K, Kosuge T: Malignant transformation of adenomatous hyperplasia to hepatocellular carcinoma. Lancet 336:1150–1153, 1990
Ferrell L, Wright T, Lake J, Roberts J, Ascher N: Incidence and diagnostic features of macroregenerative nodules vs. small hepatocellular carcinoma in cirrhotic livers. Hepatology 16:1372–1381, 1992
Theise ND, Lapook JD, Thung SN: A macroregenerative nodule containing multiple foci of hepatocellular carcinoma in a noncirrhotic liver. Hepatology 17:993–996, 1993
Kenmochi K, Sugihara S, Kojiro M: Relationship of histologic grade of hepatocellular carcinoma (HCC) to tumor size and demonstration of tumor cells of multiple different grades in single small HCC. Liver 7:18–26, 1987
Sakamoto M, Hirohashi S, Shimosato Y: Early stages of multistep hepatocarcinogenesis: Adenomatous hyperplasia and early hepatocellular carcinoma. Hum Pathol 22:172–178, 1991
Sugihara S, Nakashima O, Kojiro M, Majima Y, Tanaka M, Tanikawa K: The morphologic transition in hepatocellular carcinoma. A comparison of the individual histologic features disclosed by ultrasound-guided fine-needle biopsy with those of autopsy. Cancer 70:1488–1492, 1992
Caturelli E, Squillante MM, Andriulli A, Siena DA, Cellerino C, De Luca F, Marzano MA, Rapaccini GL: Liver fine-needle biopsy in patients with severely impaired coagulation. Liver 13:270–273, 1993
Menghini G: One-second needle biopsy of the liver. Gastroenterology 35:190–199, 1958
Gibson JB, Sobin LH: Histological typing of tumours of the liver, biliary tract and pancreas.In International Histological Classification of Tumours. Geneva, World Health Organization, 1978, pp 20–25
Kondo Y: Histological features of hepatocellular carcinoma and allied disorders. Pathol Annu 2:405–430, 1985
Cohen MB, Haber MM, Holly EA, Ahn D, Bottles K, Stoloff A: Cytologic criteria to distinguish hepatocellular carcinoma from non-neoplastic liver. Am J Clin Pathol 95:125–130, 1991
Zainol H, Sumithran E: Combined cytological and histological diagnosis of hepatocellular carcinoma in ultrasonically guided fine needle biopsy specimen. Histopathology 22:581–586, 1993
Noguchi S, Yamamoto R, Tatsuta M,et al.: Cell features and patterns in fine-needle aspirates of hepatocellular carcinoma. Cancer 58:321–328, 1986
Kondo F, Wada K, Nagato Y, Nakajima T, Kondo Y, Ebara M: Biopsy diagnosis of well differentiated hepatocellular carcinoma based on new morphologic criteria. Hepatology 5:751–755, 1989
Okuda K, Nakashima T, Obata H, Kubo Y: Clinicopathological studies of minute hepatocellular carcinoma. Analysis of 20 cases, including 4 hepatic resections. Gastroenterology 73:109–115, 1977
Okuda K: Early recognition of hepatocellular carcinoma. Hepatology 6:729–738, 1986
Rapaccini GL, Pompili M, Caturelli E, Fusilli S, Trombino C, Gomes V, Squillante MM, Castelvetere M, Aliotta A, Grattagliano A, Cedrone A, Fadda G: Ultrasound-guided fine-needle biopsy of hepatocellular carcinoma: Comparison between smear cytology and microhistology. Am J Gastroenterol 89:898–902, 1994
Hall-Craggs MA, Lees WR: Fine-needle biopsy: Cytology, histology or both? Gut 28:233–236, 1987
Limberg B, Hopker WW, Kommerell B: Histologic differential diagnosis of focal liver lesions by ultrasonically guided fine needle biopsy. Gut 28:237–241, 1987
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Caturelli, E., Bisceglia, M., Fusilli, S. et al. Cytological vs microhistological diagnosis of hepatocellular carcinoma. Digest Dis Sci 41, 2326–2331 (1996). https://doi.org/10.1007/BF02100122
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02100122