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 [3–5]. 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
References
[1]
S. H. Parker, K. D. Hopper, W. F. Yakes, M. D. Gibson, J. L. Ownbey, and T. E. Carter, “Image-directed percutaneous biopsies with a biopsy gun,” Radiology, vol. 171, no. 3, pp. 663–669, 1989.
[2]
B. Porter, W. Karp, and L. Forsberg, “Percutaneous cytodiagnosis of abdominal masses by ultrasound guided fine needle aspiration biopsy,” Acta Radiologica, vol. 22, no. 6, pp. 663–668, 1981.
[3]
P. M. Bret, J.-M. Sente, and M. Bretagnolle, “Ultrasonically guided fine-needle biopsy in focal intrahepatic lesions: six years' experience,” Canadian Association of Radiologists Journal, vol. 37, no. 1, pp. 5–8, 1986.
[4]
M. M. Pinto, N. A. Avila, C. I. Heller, and E. M. Criscuolo, “Fine needle aspiration of the liver,” Acta Cytologica, vol. 32, no. 1, pp. 15–21, 1988.
[5]
G. Sangalli, T. Livraghi, and F. Giordano, “Fine needle biopsy of hepatocellular carcinoma: improvement in diagnosis by microhistology,” Gastroenterology, vol. 96, no. 2, part 1, pp. 524–526, 1989.
[6]
B. Q. Starley, C. J. Calcagno, and S. A. Harrison, “Nonalcoholic fatty liver disease and hepatocellular carcinoma: a weighty connection,” Hepatology, vol. 51, no. 5, pp. 1820–1832, 2010.
[7]
S. Kakar, A. M. Gown, Z. D. Goodman, and L. D. Ferrell, “Best practices in diagnostic immunohistochemistry: hepatocellular carcinoma versus metastatic neoplasms,” Archives of Pathology and Laboratory Medicine, vol. 131, no. 11, pp. 1648–1654, 2007.
[8]
J. Bruix, M. Sherman, J. M. Llovet et al., “Clinical management of hepatocellular carcinoma. Conclusions of the barcelona-2000 EASL conference,” Journal of Hepatology, vol. 35, no. 3, pp. 421–430, 2001.
[9]
P. Ferenci, M. Fried, D. Labrecque et al., “World gastroenterology organisation global guideline. hepatocellular carcinoma (hcc): a global perspective,” Journal of Gastrointestinal and Liver Diseases, vol. 19, no. 3, pp. 311–317, 2010.
[10]
P. Sorrentino, L. Tarantino, S. D'Angelo et al., “Validation of an extension of the international non-invasive criteria for the diagnosis of hepatocellular carcinoma to the characterization of macroscopic portal vein thrombosis,” Journal of Gastroenterology and Hepatology, vol. 26, no. 4, pp. 669–677, 2011.
E. S. Cibas and S. Z. Ali, “The Bethesda system for reporting thyroid cytopathology,” American Journal of Clinical Pathology, vol. 132, no. 5, pp. 658–665, 2009.
[13]
L. J. Layfield, J. Abrams, B. Cochand-Priollet et al., “Post-thyroid FNA testing and treatment options: a synopsis of the national cancer institute thyroid fine needle aspiration state of the science conference,” Diagnostic Cytopathology, vol. 36, no. 6, pp. 442–448, 2008.
[14]
C. Bru, A. Maroto, J. Bruix et al., “Diagnostic accuracy of fine-needle aspiration biopsy in patients with hepatocellular carcinoma,” Digestive Diseases and Sciences, vol. 34, no. 11, pp. 1765–1769, 1989.
[15]
Y. Matsushiro, M. Ebara, M. Ohto, and F. Kondo, “Usefulness of percutaneous biopsy under sonographic control and histological examination in the early diagnosis of hepatocellular carcinoma,” Japanese Journal of Gastroenterology, vol. 90, no. 3, pp. 655–664, 1993.
[16]
H. A. Edmondson and P. E. Steiner, “Primary carcinoma of the liver: a study of 100 cases among 48,900,” Cancer, vol. 7, no. 3, pp. 462–503, 1954.
[17]
T. Kanai, S. Hirohashi, and M. P. Upton, “Pathology of small hepatocellular carcinoma. A proposal for a new gross classification,” Cancer, vol. 60, no. 4, pp. 810–819, 1987.
[18]
L. G. Dodd, E. E. Mooney, L. J. Layfield, and R. C. Nelson, “Fine-needle aspiration of the liver and pancreas: a cytology primer for radiologists,” Radiology, vol. 203, no. 1, pp. 1–9, 1997.
[19]
L. Appelbaum, R. A. Kane, J. B. Kruskal, J. Romero, and J. Sosna, “Focal hepatic lesions: US-guided biopsy—lessons from review of cytologic and pathologic examination results,” Radiology, vol. 250, no. 2, pp. 453–458, 2009.
[20]
S. Bergman, F. Graeme-Cook, and M. B. Pitman, “The usefulness of the reticulin stain in the differential diagnosis of liver nodules on fine-needle aspiration biopsy cell block preparations,” Modern Pathology, vol. 10, no. 12, pp. 1258–1264, 1997.
[21]
W. B. de Boer, A. Segal, F. A. Frost, et al., “Can CD34 discriminate between benign and malignant hepatocytic lesions in fine-needle aspirates and thin core biopsies?” Cancer, vol. 90, no. 5, pp. 273–278, 2000.
[22]
N. Shafizadeh, L. D. Ferrell, and S. Kakar, “Utility and limitations of glypican-3 expression for the diagnosis of hepatocellular carcinoma at both ends of the differentiation spectrum,” Modern Pathology, vol. 21, no. 8, pp. 1011–1018, 2008.
[23]
L. Wilkens, T. Becker, B. Schlegelberger, H. H. Kreipe, and P. Flemming, “Preserved reticulin network in a case of hepatocellular carcinoma,” Histopathology, vol. 48, no. 7, pp. 876–878, 2006.
[24]
H. Hong, B. Patonay, and J. Finley, “Unusual reticulin staining pattern in well-differentiated hepatocellular carcinoma,” Diagnostic Pathology, vol. 6, no. 1, p. 15, 2011.
[25]
A. Wee, “Fine needle aspiration biopsy of hepatocellular carcinoma and hepatocellular nodular lesions: role, controversies and approach to diagnosis,” Cytopathology, vol. 22, no. 5, pp. 287–305, 2011.
[26]
E. S. Chan and M. M. Yeh, “The Use of Immunohistochemistry in Liver Tumors,” Clinics in Liver Disease, vol. 14, no. 4, pp. 687–703, 2010.
[27]
D. Jain, “Diagnosis of hepatocellular carcinoma: fine needle aspiration cytology or needle core biopsy,” Journal of Clinical Gastroenterology, vol. 35, no. 5, supplement 2, pp. S101–S108, 2002.
[28]
European Association for The Study Of The L and European Organisation for R, “Treatment Of C. EASL-EORTC clinical practice guidelines: management of hepatocellular carcinoma,” Journal of Hepatology, vol. 56, no. 4, pp. 908–943, 2012.
[29]
S. Yao, J. Zhang, H. Chen, et al., “Diagnostic value of immunohistochemical staining of GP73, GPC3, DCP, CD34, CD31, and reticulin staining in hepatocellular carcinoma,” Journal of Histochemistry & Cytochemistry, vol. 61, no. 9, pp. 639–648, 2013.
[30]
J. Bruix and M. Sherman, “Management of hepatocellular carcinoma: an update,” Hepatology, vol. 53, no. 3, pp. 1020–1022, 2011.
[31]
S. Gupta, S. Bent, and J. Kohlwes, “Test characteristics of α-fetoprotein for detecting hepatocellular carcinoma in patients with hepatitis C: a systematic review and critical analysis,” Annals of Internal Medicine, vol. 139, no. 1, pp. 46–50, 2003.
[32]
A. S. Befeler, P. H. Hayashi, and A. M. Di Bisceglie, “Liver transplantation for hepatocellular carcinoma,” Gastroenterology, vol. 128, no. 6, pp. 1752–1764, 2005.
[33]
V. Mazzaferro, E. Regalia, R. Doci et al., “Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis,” New England Journal of Medicine, vol. 334, no. 11, pp. 693–699, 1996.
[34]
F. Y. Yao, “Liver transplantation for hepatocellular carcinoma: beyond the Milan criteria,” American Journal of Transplantation, vol. 8, no. 10, pp. 1982–1989, 2008.
