Cell Block and IHC: A New Weapon in Diagnostic Armamentarium in Differentiating Liver Sol

Abstract

Background: The diagnosis of hepatic lesion often requires characteristic cytologic features in dearth of which the diagnosis may not be clear. Cell block and immunohistochemistry (IHC) have emerged as a new weapon in diagnostic armamentarium. Objective: This study was planned to investigate the cytomorphological features of distinctive non-neoplastic and neoplastic lesions of the liver and to evaluate the sensitivity, specificity and diagnostic accuracy of ultrasound-guided FNAC and cell block in the diagnosis of liver sol. Method: This study was conducted during the period of February 2010 to March 2013. One hundred and fifty-one cytological materials were collected from patients with focal liver lesions who were referred after initial clinical and radiological assessment for ultrasound-guided fine needle aspiration cytology (USG-FNAC). Results: Age of patients ranged from 10 to 61 years and 75 (71%) of these patients were males. out of 151 investigated samples 106 (70%) and 45 (30%) were malignant by cytology and cell block respectively. 91 patients were investigated by both cytology and cell blocks and were included in the final analyses of the FNAC in comparison to cell block. IHC markers were used in 41 patients. The sensitivity, specificity, positive predictive value and negative predictive value of the cytology were 95% (90.0–99%), 60.3% (43.2–76.0%), 73.8% (59–78.3%) and 0 (0–13.3%), respectively. the malignant focal lesions were hepatocellular carcinoma (35.7%), metastatic adenocarcinoma (32%), spindle cell sarcoma (3.3%) and hepatoblastoma (1.2%). IHC was able to give an add-on diagnosis in 31 (20.3%) adding to overall sensitivity and specificity. Conclusion: Cell block and IHC are useful adjunct in making differential diagnosis of liver space occupying lesions. These can increase both the sensitivity and specificity of FNAC in liver sol.