Abstract
Background: Liver is a common organ for lodgement of various infections and metastasis from other parts of body. Fine needle aspiration cytology (FNAC) plays a major decisive diagnostic role and combined with USG diagnostic accuracy is 90-95% minimizing the need of biopsy. An increased in serum AFP concentration has been observed in Hepatocellular Carcinoma (HCC) and is an important serum tumor marker. Methods: The present study was done, with the aim of studying the cytomorphological features of hepatic lesions and their association with serum Alpha Fetoprotein (AFP) levels. Study was conducted on 56 patients who underwent USG guided FNAC for diagnosis of liver lesions. Cytomorphological pattern of liver lesions were studied and serum AFP levels of the same cases were measured. Results: Maximum number of cases was in age group of 61-70 years. Male: Female ratio was 1.4:1. 82.1% cases were malignant. Most common malignancy was Metastatic deposits of Adenocarcinoma (MDA). HCC was diagnosed in 5.4% cases. Serum AFP levels in HCC were 459.93 ± 41.69 ng/mL.15.4 % of the cases of MDA and 8.3% of the cases of Metastatic deposits of Poorly Differentiated Carcinoma (MDPDC) showed raised serum AFP levels. Association between cytodiagnosis and serum AFP range was statistically significant. Sensitivity=100%, specificity=81.4%, PPV=27.3% and NPV= 100% were obtained when serum AFP was used to differentiate metastatic lesions with HCC taking < 8.5ng/mL as cut off. Conclusion: USG guided FNAC of the liver is a rapid, reliable and economical screening test. Serum AFP has been the most widely used tumor marker for diagnosing HCC but raised levels are also seen in other hepatic lesions decreasing its specificity.
 Keywords: Liver, FNAC, Serum Alpha fetoprotein levels
Highlights
Liver is a vital organ which maintains the body's metabolic homeostasis.[1]
Fine needle aspiration cytology (FNAC) plays a major decisive diagnostic role and combined with USG diagnostic accuracy is 9095% minimizing the need of biopsy
In a study done by Kapadiya et al, age of cases with liver lesion ranged from 20 88 years and the maximum number of cases were in between 50-69 years.[10]
Summary
Liver is a vital organ which maintains the body's metabolic homeostasis.[1]. Besides this, it is a common organ for lodgment of various infections and metastasis of tumors from various parts of the body especially the gastrointestinal tract.[2]. Fine needle aspiration cytology (FNAC) plays a major decisive role and performing Ultrasonography (USG) guided FNAC helps to diagnose these lesions with 9095% accuracy and minimizes the requirement of biopsy.[4] FNAC offers accuracy without significant complication and requires minimal intervention, so warrants consideration early in investigative sequence.[3] Inflammatory lesions and diffuse liver diseases may mimic mass like lesions or appear as non-homogeneous lesions on radiological evaluation Such lesions can be sampled by FNA to rule out neoplasms and differentiate them from other benign and non- neoplastic lesions.[5] Alpha fetoprotein (AFP) is a major serum protein in the fetus, but the concentrations decrease rapidly after birth, and by the second year of life and after that only trace amounts are normally detected in serum.
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