Nazir Raja Tariq, Sharif Muhammad Ashraf, Iqbal Muhammad, Amin Muhammad Shahbaz
Department of Histopathology, Armed Forces Institute of Pathology, Rawalpindi.
J Coll Physicians Surg Pak. 2010 Jun;20(6):373-6.
To determine the diagnostic accuracy of fine-needle aspiration cytology (FNAC) in liver masses to isolate malignant from benign tumours and hepatocellular carcinoma (HCC) from metastatic tumours.
Cross-sectional, observational.
Department of Histopathology, Combined Military Hospital, Peshawar, from June 2004 to June 2005.
All the patients with liver masses confirmed by ultrasonography, irrespective of age and gender, were included. Patients with inflammatory lesions were excluded from the study. Selected patients underwent fine-needle aspiration under ultrasound guidance followed by needle biopsy. The cytological slides were stained by haematoxylin and eosin (H & E) stain, while Papanicolaou's stain was employed in selective cases. Needle biopsy fragments were fixed in formalin followed by paraffin embedding and staining with H and E stain. Sensitivity and specificity of FNAC in the diagnosis of liver masses was determined using histological diagnosis on liver biopsy as gold standard.
There were one hundred subjects. The mean age at presentation was 55 + or - 12 years with male to female ratio of 1.7:1. Cytological diagnosis in 19 cases was benign/non-neoplastic and 81 was malignant. Out of the latter, 49 (60.49%) were HCC and 32 (39.51%) were metastatic tumours on cytology. The overall sensitivity, specificity and accuracy of FNAC in the diagnosis of malignant lesions was 95.2%, 100% and 96% respectively using histological diagnosis on liver biopsy as gold standard. Sensitivity of FNAC to differentiate HCC from metastatic tumours in liver was 96% while specificity was 100% having a diagnostic accuracy of 97.5%. The discrepancy in cyto-histological comparison was mainly seen in welldifferentiated and poorly-differentiated HCCs.
FNAC of the liver masses is a simple, safe, accurate, economical screening test without significant morbiditythat can be used to identify the vast majority of hepatic neoplasms of primary or metastatic nature with high sensitivity, specificity and diagnostic accuracy.
确定细针穿刺细胞学检查（FNAC）对肝脏肿块进行良恶性肿瘤鉴别以及肝细胞癌（HCC）与转移性肿瘤鉴别的诊断准确性。
横断面观察性研究。
2004年6月至2005年6月，白沙瓦联合军事医院组织病理学科室。
纳入所有经超声检查确诊为肝脏肿块的患者，不限年龄和性别。炎症性病变患者被排除在研究之外。选定的患者在超声引导下进行细针穿刺，随后进行针吸活检。细胞学涂片用苏木精和伊红（H&E）染色，部分病例采用巴氏染色。针吸活检组织块用福尔马林固定，然后进行石蜡包埋并用H&E染色。以肝活检的组织学诊断为金标准，确定FNAC对肝脏肿块诊断的敏感性和特异性。
共有100名受试者。就诊时的平均年龄为55±12岁，男女比例为1.7:1。细胞学诊断为良性/非肿瘤性的有19例，恶性的有81例。在后者中，细胞学检查显示49例（60.49%）为HCC，32例（39.51%）为转移性肿瘤。以肝活检的组织学诊断为金标准，FNAC对恶性病变诊断的总体敏感性、特异性和准确性分别为95.2%、100%和96%。FNAC鉴别肝脏HCC与转移性肿瘤的敏感性为96%，特异性为100%，诊断准确性为97.5%。细胞组织学比较的差异主要见于高分化和低分化的HCC。
肝脏肿块的FNAC是一种简单、安全、准确、经济的筛查方法，发病率低，可用于以高敏感性、特异性和诊断准确性识别绝大多数原发性或转移性肝脏肿瘤。
