Fine needle aspiration cytopathology of liver masses: 101 cases with cyto-/histopathological analysis

Objective: Appropriate clinical management of a hepatic mass depends on its accurate diagnosis. We aimed to evaluate sensitivity, specificity and accuracy of percutaneous fine needle aspiration cytopathology (FNAC) in the diagnosis of suspicious liver masses in our center.

Study design: Cytopathology and histopathology databases were searched for patients undergoing combined, image-guided percutaneous FNAC and biopsy sampling of liver mass lesions in 2006-2011. All patients had one or more radiologically detected lesion and clinical suspicion of neoplastic disease. Sensitivity, specificity and accuracy of FNAC in the diagnosis of liver lesions were determined using histopathological diagnoses on liver biopsy as a gold standard.

Results: Of 101 patients, cytopathological diagnoses were nonneoplastic in 10 cases while 10 cases were suspicious for neoplasms and 71 were malignant. In 10 patients (9.9%), FNA samples were inadequate for assessment. Final histopathological diagnoses were nonneoplastic in 7 cases, benign tumoral in 5 and malignant in 89 cases (88.1%). Of the malignancies, 22 (24.7%) were hepatocellular carcinomas (HCC) and 60 (67.4%) were metastatic tumors on final clinicohistopathological analysis. The remaining 7 (7.8%) patients had other primary hepatic malignancies. Fifteen of the 22 (68.2%) HCC cases were specifically diagnosed by FNAC. In 28 of the metastatic tumors, the primary organ site was unknown, followed by gastrointestinal malignancies in 17 cases. Overall, sensitivity, specificity, accuracy, and positive and negative predictive values of FNAC in the diagnosis of neoplastic lesions were 96.3, 90.0, 95.6, 98.7 and 75.0%, respectively. Discrepancy in cyto-/histopathological data was mainly seen in nonrepresentative FNAC cases.

Conclusion: FNAC of liver masses is a highly accurate technique that can be used to identify the majority of primary/metastatic hepatic neoplasias with high specificity. A combined cyto-/histopathological approach provides higher accuracy in the diagnosis and typing of hepatic tumors, which may affect therapeutic decisions. Correlation of cytopathology with clinicoradiological findings is helpful to increase overall accuracy of the procedure.