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| |  CT-Guided Fine-Needle Aspiration Provides Accuracy for Liver Biopsy: Presented at ASCP By Lexa W. Lee NEW ORLEANS, LA -- October 24, 2007 -- Fine needle aspiration (FNA) cytology guided by computed tomography (CT) is highly accurate in evaluating liver lesions, according to a study presented here at the 2007 annual meeting of the American Society for Clinical Pathology (ASCP). Because of its high degree of sensitivity and specificity, FNA is used commonly for diagnosis of liver lesions. Sensitivity ranges from 67% to 100% and specificity from 80% to 100%. Immunohistochemistry (IHC), while also useful, can be difficult to interpret if the specimen is too small, according to Howard Wu, Consulting Pathologist, Ball Memorial Hospital in Muncie, Indiana, United States. At this hospital, CT-guided percutaneous FNA with immediate onsite evaluation of liver masses is performed. Dr. Wu and colleagues wanted to evaluate further the accuracy of liver FNA in a community-hospital setting because published studies are limited. Therefore, they conducted a retrospective review of 391 consecutive CT-guided FNA biopsies performed from 1996 to 2005. Of the total cohort, 48% were male and 52% were female, with ages ranging from 14 to 90 years. Cases were divided into four categories based on diagnosis: benign; indeterminate; non-diagnostic; and malignant. Out of 391 diagnoses, 73% (286) were malignant, 7% (21) were primary cancers, 88% (252) were metastatic, and 5% (13) were unknown. The most common forms of metastatic cancer were adenocarcinomas (127 cases), neuroendocrine carcinomas (55), poorly-differentiated carcinomas (41), and lymphomas (11). Among tumours with a known primary site, the most common site of origin was lung (41), colon (28), pancreas (24), liver (21), breast (18), and lymphatic (12). In 109 of the total cases, the primary sites were unknown; in eight cases, the diagnosis was indeterminate (atypical cells). When biopsies were repeated, two of these eight cases were found to be adenocarcinomas. Initially, 77 of the total sample were diagnosed as benign, but repeat biopsies of 14 revealed two malignant neoplasms. There were two cases which were non-diagnostic. Dr. Wu said, "In this study, the diagnostic rate for CT-guided liver FNA was 95%; the sensitivity was 99%, and the specificity was 100%. At our institution, the most common liver lesion evaluated by FNA is metastatic carcinoma. The primary site of metastatic lesions is often unknown; the most common known sites are lung, colon, and pancreas. Adenoma is by far the most common malignancy metastasising to the liver."
[Presentation title: CT-Guided Fine-Needle Aspiration Biopsy of Liver: 10 Years' Experience in a Community Teaching Hospital. Poster 86]
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