title: Utility of FNAC in Conjunction with Cell Block for Diagnosing Space-Occupying Lesion (SOL) of Liver with Emphasis on Differentiating Hepatocellular Carcinoma from Metastatic SOL: Analysis of 61 Cases.
abstract: OBJECTIVE
  To study the cytological patterns of fine-needle aspiration cytology (FNAC) obtained from space-occupying lesions (SOLs) of the liver with an aim to differentiate primary hepatocellular carcinoma from metastatic deposits and to evaluate the added advantage and efficacy of studying cell blocks in conjunction with smears for enhancing diagnostic accuracy.  .
  
  
  METHODS
  This prospective study took place over two years (September 2007 to 2009) and included 61 patients with cases of liver SOLs that were clinically or radiologically suspicious for malignancy and who were referred for computed tomography or ultrasonography-guided FNAC. Smears were prepared from the aspirated material, and any remainder was used to make the cell block (n = 55). A final diagnosis was made after evaluating the smears and cell block sections.  .
  
  
  RESULTS
  On cytomorphology, a diagnosis of moderately differentiated hepatocellular carcinoma (HCC) and metastatic carcinoma was made in 10 (18.2%) and 25 (45.5%) cases, respectively, and were confirmed using cell block sections. In cases where it was difficult to differentiate between well-differentiated HCC and regenerative nodules, and between poorly differentiated HCC and poorly differentiated metastatic carcinoma, a final diagnosis was made with the help of cell blocks sections. Cell blocks assisted in reaching a final diagnosis in 16 (29.1%) cases. Cases that were diagnosed using cytomorphology were confirmed by the cell block method. In these 39 (70.9%) cases we were able to render a diagnosis with much more confidence.  .
  
  
  CONCLUSIONS
  In our experience, difficulties in diagnosing SOL liver are attributed to differentiation of the tumor. Cell block preparation gives an additional advantage as architectural details can be studied that help to reach an accurate diagnosis in problematic and challenging cases. Thus, we strongly recommend the use of the cell block technique in conjunction with cytosmears for the purpose of diagnosis.
authors.affiliation: Department of Pathology, Sheri Kashmir Institute of Medical Sciences, Kashmir, India.
authors.forename: Haq
authors.initials: H
authors.lastname: Sheefa
authors.affiliation: Department of Pathology, Indraprastha Apollo Hospitals, Delhi, India.
authors.forename: Jadhav
authors.initials: J
authors.lastname: Lata
authors.affiliation: Department of Pathology, Sheri Kashmir Institute of Medical Sciences, Kashmir, India.
authors.forename: Mubeen
authors.initials: M
authors.lastname: Basharat
authors.affiliation: Department of Pathology, Sheri Kashmir Institute of Medical Sciences, Kashmir, India.
authors.forename: Makhdoomi
authors.initials: M
authors.lastname: Rumana
authors.affiliation: Department of Pathology, Indraprastha Apollo Hospitals, Delhi, India.
authors.forename: Malhotra
authors.initials: M
authors.lastname: Veena
keywords: Aspiration Biopsy, Fine-Needle; Carcinoma, Hepatocellular; Cell Block; Hep Par