Diagnostic accuracy and standardization of fine needle biopsy in the characterization of liver nodules in cirrhosis.

Abstract

e14576 Background: The diagnostic sensitivity of fine needle biopsy (FNB) for liver nodules in cirrhotic patients is both operator and disease characteristic dependant. The performance FNB needs to be not standardized. Aim: To compare the diagnostic accuracy of one vs. two FNB intra-nodule plus one extra-nodule passage. Methods: A FNB was performed with a 21-gauge trenchant needle for microhistology (Biomol, HS Hospital Service, Italy) with two passages within and one outside the nodule, and processed separately. The diagnosis was made by histology and confirmed by enhanced follow-up for non malignant lesions. FNB was repeated in all patients with unsolved histological diagnosis, i.e., similar histologic features within and outside the liver nodule. Patients with non malignant nodules underwent a repeat US every 3 months, an abdominal CT/MRI every 6 months and repeated FNB if nodules changed in size/vascular pattern. The histological diagnosis was according the International Working Party criteria. Results: 48 prospectively enrolled cirrhotics, 44 (92%) Child-Pugh A, had 67 liver nodules (mean diameter 1.9 cm); 2 (3%) < 1 cm, 39 (58%) 1-2 cm, 15 (22%) 2-3 cm, 11 (17%) > 3 cm. The final diagnosis was 41 (61%) hepatocellular carcinoma (HCC), 1 (2%) cholangiocarcinoma (CCC), 15 (22%) MRN, 4 (6%) low grade dysplastic nodule (LGDN), 4 (6%) high grade dysplastic nodule (HGDN), 2 (3%) lymphoma. 36 HCC (82%) were diagnosed with first passage whereas 5 additional HCC (8%) were diagnosed with the second passage. FNB needed to be repeated in 2 (3%) cases with similar histological features within and outside the liver nodule. In the 39 nodules of 1-2 cm, the corresponding final diagnosis was: 17 (43%) HCC, 1 (3%) CCC, 3 (8%) MRN, 11 (28%) LGDN, 5 (13%) HGDN, 2 (5%) lymphoma. Fifteen HCC (37%) were identified by one passage and 2 (5%) by two passages. FNB needed to be repeated in 2 patients. A parenchymal sub-glissonian hematoma (1%) was the only complication. Conclusions: Two passages FNB allows to increase by 12% the final diagnosis of HCC in small liver nodules detected during surveillance of patients with cirrhosis. No significant financial relationships to disclose.