Role of fine needle aspiration cytology in management of hepatocellular carcinoma: a single centre experience [Uloga citološke punkcije u strategiji hepatocelularnog karcinoma: iskustvo jednog centra]

Mrzljak, Anna and Kardum-Skelin, Ika and Čolić Cvrlje, Vesna and Filipec-Kanižaj, Tajana and Šušterčić, Dunja and Škegro, Dinko (2010) Role of fine needle aspiration cytology in management of hepatocellular carcinoma: a single centre experience [Uloga citološke punkcije u strategiji hepatocelularnog karcinoma: iskustvo jednog centra]. Collegium Antropologicum, 34 (2). pp. 381-385. ISSN 0350-6134

Preview

PDF - Published Version Download (103kB) | Preview

Abstract

Hepatocellular carcinoma (HCC) mostly occurs in chronic liver disease and cirrhosis. Liver resection and liver transplantation (LT) represent potentially curative treatments of choice and if not feasible, palliative strategies such as percutaneous interventional techniques (PITs) and chemotherapy (ChT) are considered. Elevated alfa-fetoprotein, typical imaging pattern, needle core biopsy (NCB) and fine needle aspiration cytology (FNAC) complement diagnostic assessment of HCC. We have retrospectively analyzed all patients with contraindications for NCB in which HCC was diagnosed by FNAC during consecutive 5 years in our hospital. Ultrasound guided FNAC provided a safe method of approach and, except for mild transitory discomfort at the site of puncture, no complications were documented. The diagnosis was established on May-Grünwald-Giemsa (MGG) stained aspirates and additional immunocytochemistry. Of our 62 patients, HCC developed in 61.3% cirrhotic and 38.7% non-cirrhotic livers. In the setting of cirrhosis 18.4% of patients underwent LT, 15.8% PITs, 26.3% ChT and 39.5% symptomatic therapy. In non-cirrhotic setting 46% of patients underwent liver resection, and PIT, ChT and symptomatic therapy were applied in 4%, 25%, 25% of cases, respectively. Pathohistology of resected and explanted livers (18 cases) confirmed the initial diagnosis made on FNAC. Since only early stage of HCC has a better prognosis, every effort should be made to establish prompt and accurate diagnosis. Our observations demonstrate that FNAC offers minimally invasive, rapid and uncomplicated diagnostic approach, with sensitivity from 67% to 93% and specificity from 96% to 100%. FNAC, is of utmost importance in the setting of abnormal coagulation tests and ascites commonly seen in advanced liver disease, facilitating diagnostic workup and treatment decisions.

Abstract in Croatian

Hepatocelularni karcinom (HCC) se razvija uglavnom u kroničnoj bolesti jetre ili cirozi. Resekcija i transplantacija jetre (LT) su potencijalne metode izlječenja HCC, no ukoliko nisu primjenjive, dolaze u obzir palijativne strategije poput perkutane interventne tehnike (PITs) i kemoterapije (ChT). Povišeni alfa-fetoprotein; tipični morfološki prikaz, iglena biopsija (core needle biopsy – NCB) i citološka punkcija (fine needle aspiration cytology – FNAC) komplementarne su metode u dijagnostici HCC. Analizirali smo sve bolesnike s kontaindikacijom za NCB kod kojih je HCC dijagnosticiran citološkom punkcijom u razdoblju od 2004.–2009. godine u našoj ustanovi. Citološka punkcija učinjena je pod kontrolom ultrazvuka te osim prolazne nelagode na mjestu punkcije nisu opažene druge komplikacije. Dijagnoza je postavljena na citološkim razmazima obojenim May-Grunwald-Giemsa bojenjem i imunocitokemijski. Od ukupno 62 bolesnika, HCC se razvio u 61,3% bolesnika s cirozom jetre te u 38,7% bolesnika bez ciroze jetre. Kod ciroze jetre u 18,4% bolesnika izvršena je LT, 15,8% PITs, 26,3% ChT te je u 39,5% provedena simptomatska terapija. U skupini bolesnika bez ciroze, kod 46% bolesnika je izvršena resekcija, u 4% primjenjen je PITs, u 25% ChT i u 25% simptomatska terapija. Patohistološka analiza reseciranih i eksplantiranih jetri (18 slučajeva) potvrdila je citološku dijagnozu. Budući rani stadiji bolesti imaju bolju prognozu, potrebna je brza i točna dijagnostika. Naša zapažanja ukazuju da je FNAC minimalno invazivna, brza i jednostavna dijanostička metoda sa osjetljivošću od 67% do 93% i specifičnošću od 96% do 100. Citološka punkcija, naročito u slučajevima uzapredovale bolesti jetre s komplikacijama (loša koagulacija i ascites) omogućuje rano postavljanje dijagnoze, te time i raniji početak liječenja.

Actions (login required)

View Item

Downloads