CYTOLOGICAL VS MICROHISTOLOGICAL DIAGNOSIS OF HEPATOCELLULAR-CARCINOMA - COMPARATIVE ACCURACIES IN THE SAME FINE-NEEDLE BIOPSY SPECIMEN

There is still debate over the relative merits of cytology and histolo gy in diagnosing hepatocellular carcinoma in cirrhotic livers. Previou s comparisons of the diagnostic accuracies of these two methods may ha ve been biased by sampling errors due to multiple punctures. We compar ed the diagnostic accuracies of cytology and microhistology using tiss ue and cells from the same point in liver nodules subsequently proved to be hepatocellular carcinoma. A single ultrasound-guided liver-nodul e biopsy was obtained with a 20- to 21-G cutting needle from 131 cirrh otic patients. The solid portion of samples was used for microhistolog y; the remainder was subjected to smear cytology. The results of each type of examination were expressed as true positive, nonspecific malig nancy, false negative, or inadequate for diagnosis. No false-positive diagnoses were made in 13 benign lesions. In 118 HCC nodules (particul arly those < 30 mm in diameter), cytology provided a significantly hig her percentage of correct diagnoses (85.6%) that was only slightly inf erior to that based on results of both studies (89.8%). The single-bio psy technique generally provides adequate tissue for histology and cyt ology specimens with a high cellularity. It reduces both the cost and the risks of fine-needle biopsy diagnosis of hepatocellular carcinoma.