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Liver

  • Xiaoqi LinEmail author
  • Brandon A. Umphress
  • Ernest F. WigginsIII
  • Ramona Gupta
  • Albert A. NemcekJr.
Chapter

Abstract

The main indication for fine-needle aspiration (FNA) biopsy of the liver is the diagnosis of localized disease by imaging studies, including hepatocellular carcinoma (HCC) and metastatic neoplasms from either a known or unknown primary tumor. The overall sensitivity, specificity, and accuracy of FNA in the diagnosis of malignant lesions is 92% to 96%, 92% to 100%, and 96%, respectively. Sensitivity of FNA to differentiate HCC from metastatic tumors in the liver is approximately 96%, with a specificity of 100% and a diagnostic accuracy of 97.5%. FNA of benign liver lesions poses an increased diagnostic challenge. Aspiration of cystic lesions, which is less frequently performed, can help in detecting a possible neoplastic origin of the cyst or accompanying microorganisms. As imaging studies have improved, FNA has become less useful for diagnosis of hepatitis and cirrhosis. Moreover, differentiation between cirrhosis and benign hepatocellular lesions (i.e., regenerative nodules) by FNA remains difficult.

Keywords

Liver Liver cytopathology Liver radiology Liver histopathology Hepatology 

References

  1. 1.
    Geisinger KR, Stanley MW, Raab SS, Silverman JF, Abati A. Liver. In: Geisinger KR, Stanley MW, Raab SS, Silverman JF, Abati A, editors. Modern cytopathology. London: Churchill Livingstone, Elsevier; 2004. p. 505–42.Google Scholar
  2. 2.
    Nazir RT, Sharif MA, Iqbal M, Amin MS. Diagnostic accuracy of fine needle aspiration cytology in hepatic tumours. J Coll Physicians Surg Pak. 2010;20:373–6.PubMedGoogle Scholar
  3. 3.
    Conrad R, Castelino-Prabhu S, Cobb C, Raza A. Cytopathologic diagnosis of liver mass lesions. J Gastrointest Oncol. 2013;4:53–61.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Wee A. Fine-needle aspiration biopsy of hepatocellular carcinoma and related hepatocellular nodular lesions in cirrhosis: controversies, challenges, and expectations. Pathol Res Int. 2011;2011:587936.CrossRefGoogle Scholar
  5. 5.
    Wang P, Meng ZQ, Chen Z, Lin JH, Ping B, Wang LF, et al. Diagnostic value and complications of fine needle aspiration for primary liver cancer and its influence on the treatment outcome—a study based on 3011 patients in China. Eur J Surg Oncol. 2008;34:541–6.PubMedCrossRefGoogle Scholar
  6. 6.
    Livraghi T, Damascelli B, Lombardi C, Spagnoli I. Risk in fine-needle abdominal biopsy. J Clin Ultrasound. 1983;11:77–81.PubMedCrossRefGoogle Scholar
  7. 7.
    Smith EH. Complications of percutaneous abdominal fine-needle biopsy. Review. Radiology. 1991;178:253–8.PubMedCrossRefGoogle Scholar
  8. 8.
    Tyagi R, Dey P. Needle tract seeding: an avoidable complication. Diagn Cytopathol. 2014;42:636–40.PubMedCrossRefGoogle Scholar
  9. 9.
    Jurczyk MF, Zhu B, Villa C, DeFrias D, Lin X. Cytomorphology of intraductal oncocytic papillary neoplasm of the liver. Diagn Cytopathol. 2014;42:895–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Agarwal PK, Husain N, Singh BN. Cytologic findings in aspirated hydatid fluid. Acta Cytol. 1989;33:652–4.PubMedPubMedCentralGoogle Scholar
  11. 11.
    Mettler FA, Guiberteau MJ. Essentials of nuclear medicine imaging. 5th ed. Philadelphia: W.B. Saunders; 2005.Google Scholar
  12. 12.
    Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL, Chang SC. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis. 2007;45:284–93.PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Johnson CD, Schmit GD. Mayo Clinic gastrointestinal imaging review. Rochester: Mayo Clinic; 2005.Google Scholar
  14. 14.
    Horton KM, Bluemke DA, Hruban RH, Soyer P, Fishman EK. CT and MR imaging of benign hepatic and biliary tumors. Radiographics. 1999;19:431–51.PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Zeppa P, Anniciello A, Vetrani A, Palombini L. Fine needle aspiration biopsy of hepatic focal fatty change. A report of two cases. Acta Cytol. 2002;46:567–70.PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Anstee QM, McPherson S, Day CP. How big a problem is non-alcoholic fatty liver disease? BMJ. 2011;343:d3897.PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Takeshita A, Yamamoto K, Fujita A, Hanafusa T, Yasuda E, Shibayama Y. Focal hepatic steatosis surrounding a metastatic insulinoma. Pathol Int. 2008;58:59–63.PubMedCrossRefPubMedCentralGoogle Scholar
  18. 18.
    Tani M, Yamaue H, Oka M, Onishi H, Kinoshita H, Hirabayashi N, et al. Focal fatty liver after pancreaticoduodenectomy: a case report of a rare entity of intrahepatic tumor. Hepato-Gastroenterology. 2002;49:1087–9.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Gong L, Su Q, Zhang W, Li AN, Zhu SJ, Feng YM. Liver cell adenoma: a case report with clonal analysis and literature review. World J Gastroenterol. 2006;12:2125–9.PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Kutami R, Nakashima Y, Nakashima O, Shiota K, Kojiro M. Pathomorphologic study on the mechanism of fatty change in small hepatocellular carcinoma of humans. J Hepatol. 2000;33:282–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Sookoian S, Castano GO, Burgueno AL, Gianotti TF, Rosselli MS, Pirola CJ. The nuclear receptor PXR gene variants are associated with liver injury in nonalcoholic fatty liver disease. Pharmacogenet Genom. 2010;20:1–8.CrossRefGoogle Scholar
  22. 22.
    Tebala GD, Jwad A, Khan AQ, Long E, Sissons G. Multifocal nodular fatty infiltration of the liver: a case report of a challenging diagnostic problem. Am J Case Rep. 2016;17:196–202.PubMedPubMedCentralCrossRefGoogle Scholar
  23. 23.
    Hamer OW, Aguirre DA, Casola G, Lavine JE, Woenckhaus M, Sirlin CB. Fatty liver: imaging patterns and pitfalls. Radiographics. 2006;26:1637–53.PubMedCrossRefGoogle Scholar
  24. 24.
    Terriff BA, Gibney RG, Scudamore CH. Fatality from fine-needle aspiration biopsy of a hepatic hemangioma. Am J Roentgenol. 1990;154:203–4.CrossRefGoogle Scholar
  25. 25.
    Davies R. Haemorrhage after fine-needle aspiration biopsy of an hepatic haemangioma. Med J Aust. 1993;158:364.PubMedPubMedCentralGoogle Scholar
  26. 26.
    Reddy KR, Kligerman S, Levi J, Livingstone A, Molina E, Franceschi D, et al. Benign and solid tumors of the liver: relationship to sex, age, size of tumors, and outcome. Am Surg. 2001;67:173–8.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Hertzanu Y, Peiser J, Zirkin H. Massive bleeding after fine needle aspiration of liver angiosarcoma. Gastrointest Radiol. 1990;15:43–6.PubMedCrossRefPubMedCentralGoogle Scholar
  28. 28.
    Choi BY, Nguyen MH. The diagnosis and management of benign hepatic tumors. J Clin Gastroenterol. 2005;39:401–12.PubMedCrossRefPubMedCentralGoogle Scholar
  29. 29.
    Trotter JF, Everson GT. Benign focal lesions of the liver. Clin Liver Dis. 2001;5:17–42.PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Buell JF, Tranchart H, Cannon R, Dagher I. Management of benign hepatic tumors. Surg Clin North Am. 2010;90:719–35.PubMedCrossRefGoogle Scholar
  31. 31.
    Matos AP, Velloni F, Ramalho M, AlObaidy M, Rajapaksha A, Semelka RC. Focal liver lesions: practical magnetic resonance imaging approach. World J Hepatol. 2015;7:1987–2008.PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Layfield LJ, Mooney EE, Dodd LG. Not by blood alone: diagnosis of hemangiomas by fine-needle aspiration. Diagn Cytopathol. 1998;19:250–4.PubMedCrossRefGoogle Scholar
  33. 33.
    Guy CD, Yuan S, Ballo MS. Spindle-cell lesions of the liver: diagnosis by fine-needle aspiration biopsy. Diagn Cytopathol. 2001;25:94–100.PubMedCrossRefGoogle Scholar
  34. 34.
    Iannaccone R, Federle MP, Brancatelli G, Matsui O, Fishman EK, Narra VR, et al. Peliosis hepatis: spectrum of imaging findings. Am J Roentgenol. 2006;187:W43–52.CrossRefGoogle Scholar
  35. 35.
    Chute DJ, Sarti M, Atkins KA. Liver cytology. Cancer Treat Res. 2014;160:83–109.PubMedCrossRefGoogle Scholar
  36. 36.
    Horta G, Lopez M, Dotte A, Cordero J, Chesta C, Castro A, et al. Benign focal liver lesions detected by computed tomography: review of 1,184 examinations. Rev Med Chil. 2015;143:197–202.PubMedCrossRefGoogle Scholar
  37. 37.
    Hussain SM, Terkivatan T, Zondervan PE, Lanjouw E, de Rave S, Ijzermans JN, et al. Focal nodular hyperplasia: findings at state-of-the-art MR imaging, US, CT, and pathologic analysis. Radiographics. 2004;24:3–17; discussion, 8–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Nguyen BN, Flejou JF, Terris B, Belghiti J, Degott C. Focal nodular hyperplasia of the liver: a comprehensive pathologic study of 305 lesions and recognition of new histologic forms. Am J Surg Pathol. 1999;23:1441–54.PubMedCrossRefGoogle Scholar
  39. 39.
    Makhlouf HR, Abdul-Al HM, Goodman ZD. Diagnosis of focal nodular hyperplasia of the liver by needle biopsy. Hum Pathol. 2005;36:1210–6.PubMedCrossRefGoogle Scholar
  40. 40.
    Jeong YY, Yim NY, Kang HK. Hepatocellular carcinoma in the cirrhotic liver with helical CT and MRI: imaging spectrum and pitfalls of cirrhosis-related nodules. Am J Roentgenol. 2005;185:1024–32.CrossRefGoogle Scholar
  41. 41.
    Chou R, Cuevas C, Fu R, Devine B, Wasson N, Ginsburg A, et al. Imaging techniques for the diagnosis of hepatocellular carcinoma: a systematic review and meta-analysis. Ann Intern Med. 2015;162:697–711.PubMedCrossRefGoogle Scholar
  42. 42.
    Lewandowski RJ, Sato KT, Atassi B, Ryu RK, Nemcek AA Jr, Kulik L, et al. Radioembolization with 90Y microspheres: angiographic and technical considerations. Cardiovasc Intervent Radiol. 2007;30:571–92.PubMedCrossRefGoogle Scholar
  43. 43.
    Yang GC, Yang GY, Tao LC. Cytologic features and histologic correlations of microacinar and microtrabecular types of well-differentiated hepatocellular carcinoma in fine-needle aspiration biopsy. Cancer. 2004;102:27–33.PubMedCrossRefGoogle Scholar
  44. 44.
    Wee A, Nilsson B. Highly well differentiated hepatocellular carcinoma and benign hepatocellular lesions. Can they be distinguished on fine needle aspiration biopsy? Acta Cytol. 2003;47:16–26.PubMedCrossRefGoogle Scholar
  45. 45.
    Renshaw AA, Haja J, Wilbur DC, Miller TR. Fine-needle aspirates of hepatocellular carcinoma that are misclassified as adenocarcinoma: correlating cytologic features and performance in the College of American Pathologists Nongynecologic Cytology Program. Arch Pathol Lab Med. 2006;130:19–22.PubMedGoogle Scholar
  46. 46.
    Pittman ME, Brunt EM. Anatomic pathology of hepatocellular carcinoma: histopathology using classic and new diagnostic tools. Clin Liver Dis. 2015;19:239–59.PubMedCrossRefGoogle Scholar
  47. 47.
    Soyuer I, Ekinci C, Kaya M, Genc Y, Bahar K. Diagnosis of hepatocellular carcinoma by fine needle aspiration cytology. Cellular features. Acta Cytol. 2003;47:581–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Kulesza P, Torbenson M, Sheth S, Erozan YS, Ali SZ. Cytopathologic grading of hepatocellular carcinoma on fine-needle aspiration. Cancer. 2004;102:247–58.PubMedCrossRefGoogle Scholar
  49. 49.
    Nassar A, Cohen C, Siddiqui MT. Utility of glypican-3 and survivin in differentiating hepatocellular carcinoma from benign and preneoplastic hepatic lesions and metastatic carcinomas in liver fine-needle aspiration biopsies. Diagn Cytopathol. 2009;37:629–35.PubMedCrossRefGoogle Scholar
  50. 50.
    Porcell AI, De Young BR, Proca DM, Frankel WL. Immunohistochemical analysis of hepatocellular and adenocarcinoma in the liver: MOC31 compares favorably with other putative markers. Mod Pathol. 2000;13:773–8.PubMedCrossRefPubMedCentralGoogle Scholar
  51. 51.
    Crowe A, Knight CS, Jhala D, Bynon SJ, Jhala NC. Diagnosis of metastatic fibrolamellar hepatocellular carcinoma by endoscopic ultrasound-guided fine needle aspiration. Cytojournal. 2011;8:2.PubMedPubMedCentralCrossRefGoogle Scholar
  52. 52.
    Torbenson M. Review of the clinicopathologic features of fibrolamellar carcinoma. Adv Anat Pathol. 2007;14:217–23.PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    Ichikawa T, Federle MP, Grazioli L, Madariaga J, Nalesnik M, Marsh W. Fibrolamellar hepatocellular carcinoma: imaging and pathologic findings in 31 recent cases. Radiology. 1999;213:352–61.PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    Perez-Guillermo M, Masgrau NA, Garcia-Solano J, Sola-Perez J, de Agustin y de Agustin P. Cytologic aspect of fibrolamellar hepatocellular carcinoma in fine-needle aspirates. Diagn Cytopathol. 1999;21:180–7.PubMedCrossRefPubMedCentralGoogle Scholar
  55. 55.
    Sergi CM. Hepatocellular carcinoma, fibrolamellar variant: diagnostic pathologic criteria and molecular pathology update. A primer. Diagnostics (Basel). 2015;6. https://www.ncbi.nlm.nih.gov/pubmed/?term=Sergi+CM.+Hepatocellular+carcinoma%2C+fibrolamellar+variant%3A
  56. 56.
    Singh HK, Silverman JF, Geisinger KR. Fine-needle aspiration cytomorphology of clear-cell hepatocellular carcinoma. Diagn Cytopathol. 1997;17:306–10.PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Chung YE, Kim MJ, Park YN, Choi JY, Pyo JY, Kim YC, et al. Varying appearances of cholangiocarcinoma: radiologic-pathologic correlation. Radiographics. 2009;29:683–700.PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Jurczyk M, Zhu B, Laskin W, Lin X. Pitfalls in the diagnosis of hepatic epithelioid hemangioendothelioma by FNA and needle core biopsy. Diagn Cytopathol. 2014;42:516–20.PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Rasalkar DD, Chu WC, Cheng FW, Hui SK, Ling SC, Li CK. A pictorial review of imaging of abdominal tumours in adolescence. Pediatr Radiol. 2010;40:1552–61.PubMedCrossRefPubMedCentralGoogle Scholar
  60. 60.
    Weir EG, Ali SZ. Hepatoblastoma: cytomorphologic characteristics in serious cavity fluids. Cancer. 2002;96:267–74.PubMedCrossRefGoogle Scholar
  61. 61.
    Iyer VK, Kapila K, Agarwala S, Verma K. Fine needle aspiration cytology of hepatoblastoma. Recognition of subtypes on cytomorphology. Acta Cytol. 2005;49:355–64.PubMedCrossRefGoogle Scholar
  62. 62.
    Viswanathan S, George S, Ramadwar M, Medhi S, Arora B, Kurkure P. Evaluation of pediatric abdominal masses by fine-needle aspiration cytology: a clinicoradiologic approach. Diagn Cytopathol. 2010;38:15–27.PubMedGoogle Scholar
  63. 63.
    Singh V, Manalang M, Singh M, Apte U. A brief report of immunohistochemical markers to identify aggressive hepatoblastoma. Appl Immunohistochem Mol Morphol. 2017:1.  https://doi.org/10.1097/PAI.0000000000000492. [Epub ahead of print.].
  64. 64.
    Yu RS, Chen Y, Jiang B, Wang LH, Xu XF. Primary hepatic sarcomas: CT findings. Eur Radiol. 2008;18:2196–205.PubMedCrossRefGoogle Scholar
  65. 65.
    Lin CF, DeFrias D, Lin X. Epithelioid angiosarcoma: a neoplasm with potential diagnostic challenges. Diagn Cytopathol. 2010;38:154–8.PubMedGoogle Scholar
  66. 66.
    Lin X, Saad RS, Luckasevic TM, Silverman JF, Liu Y. Diagnostic value of CDX-2 and TTF-1 expressions in separating metastatic neuroendocrine neoplasms of unknown origin. Appl Immunohistochem Mol Morphol. 2007;15:407–14.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Xiaoqi Lin
    • 1
    Email author
  • Brandon A. Umphress
    • 2
  • Ernest F. WigginsIII
    • 3
  • Ramona Gupta
    • 4
  • Albert A. NemcekJr.
    • 4
  1. 1.Northwestern University, Feinberg School of Medicine, Northwestern Memorial HospitalChicagoUSA
  2. 2.Department of PathologyNorthwestern Memorial Hospital, McGaw Medical CenterChicagoUSA
  3. 3.Department of RadiologyMonmouth Medical CenterShrewsburyUSA
  4. 4.Northwestern University Feinberg School of MedicineChicagoUSA

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