ULTRASOUND-GUIDED FINE NEEDLE ASPIRATION CYTOLOGY OF HEPATIC LESIONS: A TWO-YEAR STUDY FROM A TERTIARY CARE CENTRE

Abstract

Background: After the lymph nodes, the liver is the commonest site for the lodgement of infection and of metastatic deposits, particularly from the gastrointestinal tract. Its size, anatomical position, dual blood supply and rich nutrient availability make it a favourable environment for the growth of metastatic tumour. Ultrasound guidance has largely replaced blind aspiration for the sampling of hepatic lesions. Objectives: To categorise hepatic lesions sampled by ultrasound-guided fine needle aspiration cytology (FNAC) as non-neoplastic or neoplastic and, where neoplastic, as primary or metastatic; and to describe the cytomorphological patterns encountered. Methods: One hundred consecutive patients with a hepatic lesion suspected clinically and confirmed on ultrasonography underwent ultrasound-guided FNAC over a two-year period at a tertiary care teaching hospital in Karnataka, southern India. Platelet count, bleeding time and clotting time were checked before the procedure. Air-dried smears were stained by May–Grünwald–Giemsa and Leishman methods, and alcohol-fixed smears by Papanicolaou and haematoxylin and eosin. Cystic aspirates were centrifuged and smears prepared from the sediment. Results: Patients were aged 16 to 82 years (mean 58.4 years), comprising 68 men and 32 women (male to female ratio 2.1:1). The commonest presenting complaint was right hypochondrial pain (84%), followed by an abdominal mass (67%), anorexia (58%) and weight loss (39%). Cytological examination categorised 83 lesions (83%) as malignant neoplastic and 17 (17%) as non-neoplastic. Among the neoplastic lesions, 53 (63.9%) were hepatocellular carcinoma and 30 (36.1%) were metastatic deposits. Pyogenic liver abscess was the commonest nonneoplastic lesion (12 cases, 12%), followed by granulomatous hepatitis (3 cases) and cirrhosis (2 cases). No procedurerelated complication was observed. Conclusion: Ultrasound-guided FNAC is a safe, simple and inexpensive technique that permits the categorisation of hepatic lesions into non-neoplastic, primary neoplastic and metastatic disease, and allows subtyping on cytological smears in a manner useful for clinical management. Because no histopathological correlation was undertaken, the present study characterises the spectrum of lesions encountered rather than establishing the diagnostic accuracy of the technique.