Cytodiagnosis of focal hepatic lesions by image guided fine needle biopsy

BACKGROUND: Image guided fine needle cytological diagnosis of hepatic lesions has become a routine diagnostic procedure. AIM: To analyze the diagnostic yield of fine needle cytological aspirates of the liver. PATIENTS AND METHODS: Two hundred two aspirates, obtained in 201 patients were studied. Procedures were performed under ultrasound guidance in 77.9% of cases and under CT scan guidance in 22.1%. Cytological diagnosis was compared with definitive pathological diagnosis in 136 patients and with clinical follow up in 66. RESULTS: Cytology was positive for malignant cells in 81.2% of cases, negative for malignant cells in 15.3%, inconclusive in 1% and the sample was inadequate in 2.5%. Cytology was false negative for malignant lesions in 17 cases and there were no false positives. It had a sensitivity of 90.6%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 55.3%. The histological types of malignant lesions were adenocarcinoma in 48.2% of cases, hepatocellular carcinoma in 16.5% and non specified carcinoma in 20.7%. The main sites of the primary tumors were the liver in 24.4% of cases, gallbladder and biliary tract in 20.9%, intestine in 15.1%. CONCLUSIONS: Cytological diagnosis of fine needle aspirates of the liver obtained under image guidance are a valuable support in the diagnosis of focal liver lesions.