Title: Liver Fine needle aspiration using Liquid Based Cytology
1Liver 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
2Introduction
- 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.
3Material 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 age52 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).
4Echographic 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).
5Results
- 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
6Liver 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
7- Adequacy and Evaluability of Immunocytochemical
Assay on LBC and CB samples, in Liver FNAs ( CK7,
CK20, OCH15,)
General Features LBC Cell Block
gt 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).
8Hepatocellular Carcinoma
CB
Histology
LBC
9Clear cells features in HCC (LBC)
Clear cells features in HCC (CB)
10Metastatic colorectal adenocarcinoma (mCRC)
11mCRC LBC
mCRC CB
Metastatic CRC ( LBC) CK20
Metastatic CRC ( histology) CK20
12EGF/Receptor-CB
13K-Ras mutation G12D exon 2 as detected on LBC
sample using direct sequencing technique
14Conclusion
- 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