Fine-needle aspiration cytology to distinguish dysplasia from hepatocellular carcinoma with different grades.
BACKGROUND
Distinguishing dysplasia from hepatocellular carcinoma (HCC) by fine-needle aspiration (FNA) cytology is difficult. The aim of this study was to diagnose HCC and the distinction of liver cell dysplasia from HCC with different grades by interpreting and scoring the cyto-morphological features.


METHODS
Eighty-three cirrhotic patients undertook a sonography-guided FNA and subsequent needle biopsy for the tumor. HCC was confirmed in 68 cases and cirrhosis with dysplasia in 15 cases by pathology and follow-up for longer than 2 years. Eighteen cytological features were scored as degree of one, two or three according to their presence or prominence.


RESULTS
Two cases of well-differentiated HCC were diagnosed as negative for HCC initially. The sensitivity, specificity, false positive, false negative and accuracy were 97%, 100%, 0%, 3% and 97.6% for FNA cytology in the diagnosis of HCC, respectively. The score of dysplasia was 20.8 +/- 1.3 (mean +/- SD) and lower than 26.2 +/- 3.4 in Edmondson's grade I HCC (P < 0.01), 28.9 +/- 2.9 in grade II HCC (P < 0.01), and 34.9 +/- 4.3 in grade III/IV HCC (P < 0.01). The score was also significantly lower in grade II HCC than in grade III/IV HCC (P < 0.01).


CONCLUSIONS
FNA yielded a high accuracy in the distinction of dysplasia from HCC with different grades. There is a good correlation in cyto-morphological scores of liver cell dysplasia and HCC with different grades. Dysplasia displayed the lowest score and the score increased in order from dysplasia to grade III/IV HCC.
Lin
Chen-Chun
CC
Liver Research Unit, Chang-Gung Memorial Hospital, Chang-Gung University, Taipei, Taiwan.
Lin
Chun-Jung
CJ
Hsu
Chao-Wei
CW
Chen
Yi-Cheng
YC
Chen
Wei-Ting
WT
Lin
Shi-Ming
SM
D000368:Aged; D044963:Biopsy, Fine-Needle / Q000009:adverse effects; D006528:Carcinoma, Hepatocellular / Q000209:etiology / Q000473:pathology*; D002454:Cell Differentiation; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008099:Liver / Q000473:pathology*; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology*; D008113:Liver Neoplasms / Q000209:etiology / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity