Liver Fine needle Liver Fine needle aspiration using aspiration using

Liquid Based CytologyLiquid 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

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.

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 age:52 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).

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).

Echographic features

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

Patients Males Females %

114 56 58 100

Negative* 7 15 19.2

Malignant Primary 13 8 18.4

Malignant Metastatic 36 35 62.4

Liver FNCs diagnosis

* Not evaluated in this study

Adequacy and Evaluability of Immunocytochemical Assay on LBC and CB samples, in Liver FNAs ( CK7, CK20, OCH15,…)

General Features LBC % Cell Block %

> 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).

LBC

CB

Histology

Hepatocellular Carcinoma

Clear cells features in HCC (LBC)

Clear cells features in HCC (CB)

Metastatic colorectal adenocarcinoma (mCRC)

mCRC: LBC mCRC: CB

Metastatic CRC ( LBC): CK20 Metastatic CRC ( histology): CK20

EGF/Receptor-CB

K-Ras mutation G12D exon 2 as detected on LBC sample using direct sequencing technique

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