Article

Algorithm for immediate cytologic diagnosis of hepatic tumors.

Service de Radiologie, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Université Paris, 100, Blvd. du Général Leclerc, 92110 Clichy, France.
American Journal of Roentgenology (impact factor: 2.78). 04/2008; 190(3):W208-12. DOI:10.2214/AJR.07.2549
Source: PubMed

ABSTRACT Immediate cytologic assessment of hepatic lesions can help determine the adequacy of specimens and may yield a preliminary diagnosis. The purpose of this study was to analyze the diagnostic accuracy of on-site cytologic assessment compared with definitive cytologic examination in the detection and correct subtyping of malignant hepatic lesions.
The study population included 472 consecutively registered patients with hepatic nodules who underwent sonographically guided fine-needle aspiration and core biopsies. During on-site cytologic analysis, the pathologist made a preliminary diagnosis of malignancy or negative for malignancy for each nodule. When a malignant lesion was diagnosed, immediate subtyping was attempted.
With immediate cytologic analysis, 280 (80.9%) of 346 malignant nodules were correctly identified without false-positive cases. With immediate subtyping, 113 (68.1%) of 166 cases of hepatocellular carcinoma, 28 (77.8%) of 36 cases of cholangiocarcinoma, and 113 (85.0%) of 133 cases of metastasis were detected.
High diagnostic accuracy for malignancy can be achieved with on-site cytologic evaluation of hepatic tumors. Specific diagnoses of hepatocellular carcinoma, cholangiocarcinoma, and metastasis also can be made on-site in most cases. The absence of false-positive diagnosis of malignancy at on-site cytologic examination may make additional biopsy unnecessary. We propose an algorithm for the cytohistopathologic management of hepatic tumors.

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Keywords

346 malignant nodules
 
additional biopsy unnecessary
 
core biopsies
 
definitive cytologic examination
 
false-positive diagnosis
 
fine-needle aspiration
 
hepatic lesions
 
hepatic nodules
 
hepatic tumors
 
immediate cytologic analysis
 
Immediate cytologic assessment
 
immediate subtyping
 
malignant hepatic lesions
 
malignant lesion
 
on-site cytologic analysis
 
on-site cytologic assessment
 
on-site cytologic evaluation
 
on-site cytologic examination
 
preliminary diagnosis
 
study population