Ultrasound/computerized tomography guided fine needle aspiration cytology of liver lesions

Introduction: Malignancy in the liver, primary or metastatic, is usually inoperable at the time of diagnosis and as such, portends an ominous prognosis. A diagnostic modality such as FNAC, which offers accuracy with minimal complications and requires minimal intervention at low cost, warrants consideration early in the investigation sequence. Objectives: The study has been undertaken to evaluate the diagnostic efficacy of ultrasonography (USG)/ computerized tomography (CT) guided FNAC in the diagnosis of liver lesions, to correlate FNAC diagnosis with histopathology wherever possible, to correlate FNAC diagnosis with radiology diagnosis and to study the cytological patterns of liver lesions. Materials and Methods: A prospective study of 60 patients was conducted between November 2008 and October 2010. After obtaining the detailed clinical and radiological data, patients were subjected for FNAC under USG or CT guidance. Results: Cytodiagnosis of 60 cases were categorized into 6 (10%) Non-neoplastic lesions, 53 (88.33%) malignant neoplastic lesions and 1 (1.66%) as suspicious of carcinoma. The different neoplastic lesions were 21 (39.62%) hepatocellular carcinoma, 21 (39.62%) metastatic adenocarcinoma, 6 (11.32%) metastatic poorly differentiated carcinoma and 5cases (9.43%) of unclassified malignancy. Histopathological correlation was available in 11 malignant neoplastic lesions which confirmed the diagnosis. Nineteen cases of multiple lesions described by ultrasonography and suggested differential diagnosis of metastasis and HCC proved to be metastatic in 10cases (52.63%) and HCC in 9 cases (47.36%) by cytological examination. Overall diagnostic accuracy of the FNAC of liver to detect malignant lesions was 93.75%. Conclusion: USG/CT guided FNAC of liver permits the categorization of more frequent non-neoplastic lesions and neoplastic primary and secondary metastatic malignancy in a simple and rational manner which is helpful for the management of hepatic lesions. Ultrasound guided fine needle aspiration of liver has a promising role to play in the diagnosis and classification of liver disease than ultrasonography alone, as it requires greater degree of precision to reach diagnostic accuracy.