Liver Fine needle
aspiration using
Liquid Based Cytology
G Simone, M Asselti, G Caldarola-Gadaleta, T Addati,
G Giannone, M Liuzzi, F Palma, V Rubini, F.A. Zito, V Fazio
NCI “Giovanni Paolo II” - Bari ( Italy )
22nd EUROPEAN CONGRESS OF PATHOLOGY
NATIONAL CONGRESS SIAPEC-IAP Florence, September 4-9 2009
Introduction
Only few papers have been published on the
issue of LBC in Fine Needle Cytology (FNC), of
the liver, because of its limited use in this field.
The aim of this study is to verify the use of LBC
as compared with Cell Block (CB) technique,
according to cellular and architectural features,
in liver FNC.
Material and methods
114 Patients who underwent hepatic FNA under US guidance
using a 21 G-CIBA needle, entered the study
92 43 females and 49 males (mean age 57.2 ys, range 23-87)
out of 114 cases, in which malignant cells were
evidenced, were analised
21
FNCs resulted as primary hepatocitic carcinoma of liver
(13 males and 8 females; mean age: 73.4 ys)
71
were metastatic(36 males,35 females; mean age:52 ys)
Primary carcinoma were in the following sites:
Large bowel (24), Exocrine pancreas (14), Breast (11),
biliary duct (9), Lung (6), Melanoma (1) , Others (6).
Echographic features
The mean size of 92 nodules was 24 mm (range mm. 3-90).
41% of the 92 observed nodules were single.
The nodules were single in 62.5% of primary and in 33.3%
of metastatic tumors (P = 0.022).
Primary tumors were ipoechogen in 38.1% and in 52% of
the metastatic nodules (p = 0.015).
Results
A similar amount of cells as scored 0 to 3, was founded
in 72.5% of samples.
8 cases showed to be inadequate for LBC
7 cases were inadequate for CB.
77 diagnoses of the remaining cases performed on LBC,
were confirmed on the corresponding CB.
Immunocytochemical assay (ICA) was performed on 92
cases with a total of 287 determinations :
35 (13.4%) on the monolayered smears and
225 (83.3%) on the CBs and
9 cases, where the material was available, one marker was
detected on both the two samples
3 CBs and 2 LBCs samples were unables for ICA
Liver FNCs diagnosis
Patients
Males
Females
%
114
56
58
100
Negative*
7
15
19.2
Malignant Primary
13
8
18.4
Malignant Metastatic
36
35
62.4
* Not evaluated in this study
Adequacy and Evaluability of Immunocytochemical
Assay on LBC and CB samples, in Liver FNAs ( CK7,
CK20, OCH15,…)
General Features
LBC
%
Cell Block
%
> Cellularity
5
5.5
5
5.5
Inadequate X Diagnosis
8
8.7
7
7.7
Assays*
35
13.4%
225
83.6%
Inadequate x ICA
2
5.7%
3
1.3%
* In 9 cases immunochemistry for the same marker was performed both
on LBC and CB samples ( 3 assays: ER, HSA and CD34, disagreed).
Hepatocellular Carcinoma
CB
LBC
Histology
Clear cells features in HCC (LBC)
Clear cells features in HCC (CB)
Metastatic colorectal adenocarcinoma (mCRC)
mCRC: LBC
Metastatic CRC ( LBC): CK20
mCRC: CB
Metastatic CRC ( histology): CK20
EGF/Receptor-CB
K-Ras mutation G12D exon 2 as detected on LBC sample using
direct sequencing technique
Conclusion
Morphologically, even though a better nuclear
detail is evident in LBC, structural features are
better appreciated on CB. In malignant primary
and in metastatic hepatic nodules, FNC on LBC
evidenced
a
similar
diagnostic
accuracy
as
compared with CB technique even is a smaller
amount of cells useful for immunochemistry was
available.
22nd EUROPEAN CONGRESS OF PATHOLOGY
NATIONAL CONGRESS SIAPEC-IAP. Florence, September 4-9 2009