title: Percutaneous ultrasound-guided fine-needle aspiration of portal vein thrombi as a diagnostic and staging technique for hepatocellular carcinoma.
abstract: BACKGROUND
  Detection of portal vein tumor invasion in hepatocellular carcinoma (HCC) is important in determining therapy and prognosis. Patients with portal vein thrombus (PVT) due to tumor are considered to have advanced disease and are only offered palliative therapy. Therefore, every possible attempt should be made to accurately differentiate benign from malignant PVT.
  
  
  METHODS
  In this study, 20 patients presenting to the out-patient department with a PVT and a diagnosis/diagnostic suspicion of HCC were subjected to FNAC of PVT. Clinical, cytological, and histopathological data for these patients were analyzed.
  
  
  RESULTS
  The patients had a median age of 58 years, with majority being cirrhotic (80%) and males (80%). Thirteen patients had a prior radiological diagnosis of HCC at the time of FNAC. In three patients without any mass on imaging, FNAC made the initial diagnosis and staged the disease simultaneously. 50% of the thrombi were limited to 1st-order portal vein branches (vp3). Sixteen of the aspirates were positive for malignancy with 50% of the tumors being moderately differentiated. On histologic follow-up, three of the patients with negative aspirates had bland thrombi in their portal veins. No complications resulted from the procedure.
  
  
  CONCLUSIONS
  FNAC of PVT is a simple, safe, effective, well-tolerated, and economical method for staging of patients with HCC. When used as the initial diagnostic procedure, in selected patients, it can provide the diagnosis and staging information simultaneously.
authors.affiliation: The Institute of Surgical Gastroenterology & Liver Transplantation, Centre for GI Bleed, Division of HPB Diseases, Stanley Medical College Hospital, Old Jail Road, Chennai, India, ashwinrammohan@gmail.com.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Rammohan
authors.forename: S
authors.initials: S
authors.lastname: Jeswanth
authors.forename: R
authors.initials: R
authors.lastname: Sukumar
authors.forename: L
authors.initials: L
authors.lastname: Anand
authors.forename: P Senthil
authors.initials: PS
authors.lastname: Kumar
authors.forename: U P
authors.initials: UP
authors.lastname: Srinivasan
authors.forename: R
authors.initials: R
authors.lastname: Ravi
authors.forename: P
authors.initials: P
authors.lastname: Ravichandran
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044963:Biopsy, Fine-Needle / Q000379:methods*; D006528:Carcinoma, Hepatocellular / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011169:Portal Vein / Q000473:pathology*; D018084:Ultrasonography, Interventional; D020246:Venous Thrombosis / Q000473:pathology*