Cytological spectrum of hepatic aspirates: A prospective study at tertiary care hospital of North India

Background: The ultrasound guided fine needle aspiration cytology has become optimal procedure to establish tissue diagnosis for discrete hepatic masses for their appropriate management. Aims: To study detailed cytomorphological features of hepatic aspirates and to correlate them with clinical, serum Alpha fetoprotein levels as well with radiological findings in order to distinguish benign from malignant and further to differentiate primary carcinoma from metastases. Material and Methods: This was a prospective study over period of two and half years,(January 2013 to July 2015) comprising of 150 patients with liver space occupying lesions who underwent ultrasound guided FNA. FNAC was performed under ultrasound guidance using a 21-23 guage lumbar puncture needle, fitted to a 20 ml disposable syringe attached to metallic syringe holder.1-3 passes were made to get adequate aspirates. Direct air dired smears were prepared for May Grunwald Giemsa and few smears were immediately fixed in 95% alcohol for Haematoxylin and Eosin stain. Special cytochemical stains such as Periodic acid Schiff and Ziehl Neilson were done as and when required. The stained FNA smears were examined by two cytopathologists and were categorized as satisfactory and unsatisfactory for evaluation Results: Out of 150 aspirates 10 aspirates were considered unsatisfactory for evaluation. Out of remaining 140 patients 110 were male and 30 were female. The male to female ratio was 3.6:1. The age of patients ranged from 25 to 80 years and mean age was 55 years. Neoplastic lesions (86.66%) of liver were more common than non neoplastic lesion and further metastatic deposits (66.6%) were more frequent than primary HCC (20%). Serum AFP levels were raised in HCC. HBsAg and HCV antibody positivity was observed in 70% and 6.6% cases of HCC respectively.HCC presented with solitary space occupying lesion in 76.66% patients and as multiple SOL in 33.33% cases. Among the cytomorphological features the presence of predominant trabecular pattern with transgressing vessels (70%), endothelial wrapping (20%), intracytoplasmic bile in tumor cells (33.33%), scattered atypical nuclei (88.33%) and high N/C ratio (86.66%) were the most important features which helped in distinguishing HCC from metastasis. Conclusion: The present study emphasized on stepwise algorithmic approach to fine needle aspiration diagnosis of hepatic lesions with close coorelation of clinicoradiological and serum AFP with cytomorphological features.