%0 Journal Article
%T Role of FNA and Core Biopsy of Primary and Metastatic Liver Disease
%A John P. McGahan
%A John Bishop
%A John Webb
%A Lydia Howell
%A Natalie Torok
%A Ramit Lamba
%A Michael T. Corwin
%J International Journal of Hepatology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/174103
%X Objective. To examine our experience with cytology and histology biopsy of the liver and to define methods for improvement of diagnosis of primary liver tumors. Methods. This include retrospective study of 189 biopsies of 185 liver masses for cytological or histological analysis. Patients were subdivided into two groups. Group 1 consisted of 124 suspected metastasis. Group 2 consisted of 61 suspected primary neoplasms. Biopsies were considered positive or equivocal. In equivocal cases, special stains were performed. In Group 2, cases were classified by contrast CT or MRI as to (I) classic HCC, (II) infiltrated HCC, or (Ill) equivocal. Results. Definitive diagnosis was obtained in 117/124 masses (94%) in Group 1, 48/61 masses (79%) in Group 2, and (Ill) equivocal 13 cases in Group II. In two equivocal cases in which special stains were performed, they were reclassified as HCC. In 8/13 cases, CT findings were consistent with HCC. Conclusion. Liver biopsies are useful in obtaining a definitive diagnosis of suspected metastatic liver disease. Biopsy results are less reliable in patients with suspected primary liver tumors. In these situations, strategies can include basing treatment on imaging criteria or use of newer special pathological stains. Advances in Knowledge. Use of newer special immunological stains improves accuracy in definitive diagnosis of primary liver tumors. 1. Introduction Percutaneous fine needle aspiration cytology (FNAC) and automated needle core biopsy (NCB) for histological retrieval have been used to diagnose malignancy in abdominal organs for over three decades [1, 2]. These techniques of FNAC and NCB have been useful in obtaining a diagnosis of focal liver masses [3¨C5]. In the past when previously performing liver biopsies of focal masses the biopsies often were performed for metastatic disease. However, more recently we have noticed an increasing number of biopsies for suspected hepatocellular carcinoma. The epidemiology of hepatocellular carcinoma (HCC) is changing in North America and Europe for several reasons, including the viral hepatitis epidemic and the increasing number of patients diagnosed with nonalcoholic fatty liver disease [6]. In these groups, surveillance is difficult and has included use of serum markers such as alpha feto protein (AFP) and imaging with ultrasound, CT, or MRI. However, definitive diagnosis often requires biopsy of focal masses. We have felt that we had maintained very high rate of specific diagnosis for fine needle aspiration cytology (FNAC) or needle core biopsy (NCB) for focal liver masses for
%U http://www.hindawi.com/journals/ijh/2013/174103/