title: Algorithm for immediate cytologic diagnosis of hepatic tumors.
abstract: OBJECTIVE
  Immediate cytologic assessment of hepatic lesions can help determine the adequacy of specimens and may yield a preliminary diagnosis. The purpose of this study was to analyze the diagnostic accuracy of on-site cytologic assessment compared with definitive cytologic examination in the detection and correct subtyping of malignant hepatic lesions.
  
  
  METHODS
  The study population included 472 consecutively registered patients with hepatic nodules who underwent sonographically guided fine-needle aspiration and core biopsies. During on-site cytologic analysis, the pathologist made a preliminary diagnosis of malignancy or negative for malignancy for each nodule. When a malignant lesion was diagnosed, immediate subtyping was attempted.
  
  
  RESULTS
  With immediate cytologic analysis, 280 (80.9%) of 346 malignant nodules were correctly identified without false-positive cases. With immediate subtyping, 113 (68.1%) of 166 cases of hepatocellular carcinoma, 28 (77.8%) of 36 cases of cholangiocarcinoma, and 113 (85.0%) of 133 cases of metastasis were detected.
  
  
  CONCLUSIONS
  High diagnostic accuracy for malignancy can be achieved with on-site cytologic evaluation of hepatic tumors. Specific diagnoses of hepatocellular carcinoma, cholangiocarcinoma, and metastasis also can be made on-site in most cases. The absence of false-positive diagnosis of malignancy at on-site cytologic examination may make additional biopsy unnecessary. We propose an algorithm for the cytohistopathologic management of hepatic tumors.
authors.affiliation: Service de Radiologie, Hôpital Beaujon, Assistance Publique des Hôpitaux de Paris, Université Paris, 100, Blvd. du Général Leclerc, 92110 Clichy, France. law_dp@hotmail.com
authors.forename: Lawrence F
authors.initials: LF
authors.lastname: Pupulim
authors.forename: Michèle
authors.initials: M
authors.lastname: Felce-Dachez
authors.forename: Valérie
authors.initials: V
authors.lastname: Paradis
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Vullierme
authors.forename: Magaly
authors.initials: M
authors.lastname: Zappa
authors.forename: Pierre
authors.initials: P
authors.lastname: Bedossa
authors.forename: Valérie
authors.initials: V
authors.lastname: Vilgrain
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D044963:Biopsy, Fine-Needle / Q000379:methods; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D018281:Cholangiocarcinoma / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000556:secondary; D008223:Lymphoma / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015203:Reproducibility of Results