Liver Fine needle aspiration using Liquid Based Cytology

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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
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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.

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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 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).
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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).
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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

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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
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• 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).
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Hepatocellular Carcinoma
CB
Histology
LBC
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Clear cells features in HCC (LBC)
Clear cells features in HCC (CB)
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Metastatic colorectal adenocarcinoma (mCRC)
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mCRC LBC
mCRC CB
Metastatic CRC ( LBC) CK20
Metastatic CRC ( histology) CK20
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EGF/Receptor-CB
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K-Ras mutation G12D exon 2 as detected on LBC
sample using direct sequencing technique
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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