Cytomorphological Spectrum of Hepatic Lesions on Ultrasonography (USG) or CT-Guided Fine-Needle Aspiration Cytology (FNAC) in a Tertiary Care Centre, Rajendra Institute of Medical Sciences (RIMS), Ranchi, Jharkhand, India

Abstract

Background Ultrasonography (USG)-guided fine-needle aspiration cytology (FNAC) of the liver is a primary diagnostic procedure for primary and metastatic hepatic lesions. Despite histopathology being the gold standard, the outcomes of ultrasound-guided fine needle aspiration cytology are encouraging. Aims and objective The purpose of the study is to determine the diagnostic utility of ultrasonography (USG) or computerized tomography (CT)-guided FNAC in the detection of liver lesions, to investigate cytomorphological patterns of liver lesions identified by guided FNAC, and, wherever feasible, to correlate FNAC diagnosis with histopathology and imaging modalities. Materials and methods This was a hospital-based observational study of 62 patients carried out in the Department of Pathology, Rajendra Institute of Medical Sciences (RIMS) Ranchi during a period of 1.5 years from August 2020 to February 2022. The patients with suspected hepatic lesions were subjected to ultrasound-guided or CT-guided fine needle aspiration cytology (FNAC) following clinical and radiological evaluation and cytomorphological features were analyzed. Results Cyto-morphological diagnosis of 62 cases was categorized into 19 (30.64%) non-neoplastic lesions and 43 (69.35%) malignant neoplastic lesions. The different neoplastic lesions were 17 (27.41%) hepatocellular carcinoma, 1 (1.61%) hepatoblastoma, 1 (1.61%) cholangiocarcinoma, 23 (37.09%) metastatic adenocarcinoma and one case (1.61%) of unclassified malignancy. Histopathological correlation for confirming the diagnosis could be done in 33 malignant neoplastic lesions and the concordance rate of FNAC with respect to histopathological examination (HPE) was 92.11%. Overall diagnostic accuracy of the FNAC of liver to detect malignant lesions was 98.39%. Conclusion Compared to ultrasonography alone, ultrasound or CT-guided fine needle aspiration of the liver has a more promising role in the diagnosis and classification of hepatic lesions as it demands a higher level of precision to achieve diagnostic accuracy.

Keywords: cholangiocarcinoma; core needle biopsy; cystic lesion; cytomorphology; hepatic lesion; hepatoblastoma; hepatocellular carcinoma; metastatic lesion; usg-guided fnac.