Cytohistologic correlation of cirrhosis and hepatocellular carcinoma. Pitfall in diagnosis?
OBJECTIVE
To compare the diagnostic criteria for cirrhosis and hepatocellular carcinoma (HCC) noted on liver fine needle aspirates (FNAs) and their corresponding liver needle core biopsies (NCBs).


METHODS
We reviewed FNA slides from 15 cases of cirrhosis and 6 cases of HCC and their corresponding NCBs. We compared a variety of specific nonarchitectural criteria, including small cell dysplasia (SCD) and large cell dysplasia (LCD), for distinguishing cirrhosis from HCC.


RESULTS
FNA smears diagnostically correlated with NCBs. The cytologic criterion with the greatest correlation in predicting HCC on FNA was SCD. This was not noted in all the core biopsies, probably due to sampling error. LCD was seen more frequently in cirrhosis than HCC on both cytology and histology and therefore was not a criterion useful in establishing a diagnosis of malignancy. The remaining cytologic criteria had good correlations but did not aid in diagnosing HCC.


CONCLUSIONS
FNA has good cytohistologic correlation with NCB for both cirrhosis and HCC. There is an association of SCD with HCC; however, LCD is not a reliable "precancerous" change as it is commonly seen in cirrhosis and HCC. Therefore, the presence of SCD on FNA should be reported and is an indication for close clinical follow-up to exclude HCC.
Hill
Kalisha A
KA
Department of Cytopathology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA. k-hill2@nwu.edu
Nayar
Ritu
R
DeFrias
Denise V
DV
D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000592:standards*; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000473:pathology*; D002467:Cell Nucleus / Q000473:pathology; D003593:Cytoplasm / Q000473:pathology; D003951:Diagnostic Errors / Q000517:prevention & control*; D005260:Female; D005355:Fibrosis / Q000150:complications / Q000473:pathology*; D022781:Hepatocytes / Q000473:pathology; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D013223:Statistics as Topic