Diagnosis Of Hepatic Lesions Research Articles

Image guided fine needle aspiration cytology of hepatic lesions – Two year study in a Tertiary health care centre, Telangana (Hyderabad)

Mass lesions of liver are generally evaluated by Fine needle aspiration (FNA). Aim of present study was to assess the utility of ultrasound guided FNA cytology in the diagnosis of hepatic lesions and to study the cytomorphological features of these lesions and to categorise them as inflammatory, benign and malignantPatients who have been admitted during a period between 2018 to 2021 February with suspected liver diseases were subjected to ultrasound guided FNAC and cytological assessment.Fine needle aspirations of liver were performed on 39 patients. Out of which 26 were suspected by malignant lesions and 13 of non-neoplastic lesions. Of the 39 aspirations performed on patients with suspected malignancy, 26 were diagnosed as positive (66.66%). Among other 13 non- neoplastic lesions only 6 were diagnosed positive under cytological examination by FNAC (46.15%). This could be due to more yield of material in malignant lesions than non-neoplastic lesions of liver and technical expertise of FNAIn most of the cases Cytomorphological study of Hepatic masses by fine needle aspiration yields an accurate diagnosis but in some cases correlation with other investigations and ancillary studies are required for definitive diagnosis.

Gadoxetic acid-enhanced MR imaging for hepatocellular carcinoma: molecular and genetic background.

Gadoxetic acid-enhanced magnetic resonance imaging (MRI) plays important roles in diagnosis of hepatic lesions because of its superiority in the detectability of small lesions, its differentiation ability, and its utility for the early diagnosis of hepatocellular carcinoma (HCC). In HCC, expression of organic anion transporting polypeptide (OATP) 1B3 correlates with the enhancement ratio in the hepatobiliary phase. Gadoxetic acid-enhanced MRI, an indirect molecular imaging method, reflects OATP1B3 expression in HCC. OATP1B3 expression gradually decreases from the dysplastic nodule stage to advanced HCC. Decreased expression is a sensitive marker of multistep hepatocarcinogenesis, especially in the early stages. Hypervascular HCCs commonly show hypointensity in the hepatobiliary phase corresponding to a decrease in OATP1B3; however, approximately 10% of HCCs show hyperintensity due to OATP1B3 overexpression. This hyperintense HCC shows less aggressive biological features and has a better prognosis than hypointense HCC. Hyperintense HCC can be classified into a genetic subtype of HCC with a mature hepatocyte-like molecular expression. OATP1B3 expression and the less aggressive nature of hyperintense HCC are regulated by the molecular interaction of β-catenin signaling and hepatocyte nuclear factor 4α, a tumor suppressor factor. Gadoxetic acid-enhanced MR imaging has the potential to be an imaging biomarker for HCC. KEY POINTS: • The hepatobiliary phase is a sensitive indirect indicator of organic anion transporting polypeptide1B3 (OATP1B3) expression in hepatocellular carcinoma (HCC). • The OATP1B3 expression, namely, enhancement in the hepatobiliary phase, decreases from the very early stage of hepatocarcinogenesis, contributing to early diagnosis of HCC. • HCC showing hyperintensity on the hepatobiliary phase is a peculiar genetic subtype of HCC with OATP1B3 overexpression, a less aggressive nature, and mature hepatocyte-like molecular/genetic features.

The role of T2*-weighted gradient echo in the diagnosis of tumefactive intrahepatic extramedullary hematopoiesis in myelodysplastic syndrome and diffuse hepatic iron overload: a case report and review of the literature

BackgroundExtramedullary hematopoiesis is the proliferation of hematopoietic cells outside bone marrow secondary to marrow hematopoiesis failure. Extramedullary hematopoiesis rarely presents as a mass-forming hepatic lesion; in this case, imaging-based differentiation from primary and metastatic hepatic neoplasms is difficult, often leading to biopsy for definitive diagnosis. We report a case of tumefactive hepatic extramedullary hematopoiesis in the setting of myelodysplastic syndrome with concurrent hepatic iron overload, and the role of T2*-weighted gradient-echo magnetic resonance imaging in differentiating extramedullary hematopoiesis from primary and metastatic hepatic lesions. To the best of our knowledge, T2*-weighted gradient-echo evaluation of extramedullary hematopoiesis in the setting of diffuse hepatic hemochromatosis has not been previously described.Case presentationA 52-year-old white man with myelodysplastic syndrome and marrow fibrosis was found to have a 4 cm hepatic lesion on ultrasound during workup for bone marrow transplantation. Magnetic resonance imaging revealed diffuse hepatic iron overload and non-visualization of the lesion on T2* gradient-echo sequence suggesting the presence of iron deposition within the lesion similar to that in background hepatic parenchyma. Subsequent ultrasound-guided biopsy of the lesion revealed extramedullary hematopoiesis. Six months later, while still being evaluated for bone marrow transplant, our patient was found to have poor pulmonary function tests. Follow-up computed tomography angiogram showed a mass within his right main pulmonary artery. Bronchoscopic biopsy of this mass once again revealed extramedullary hematopoiesis. He received radiation therapy to his chest. However, 2 weeks later, he developed mediastinal hematoma and died shortly afterward, secondary to respiratory arrest.ConclusionsMass-forming extramedullary hematopoiesis is rare; however, our report emphasizes that it needs to be considered in the initial differential diagnosis of hepatic lesions arising in the setting of bone marrow disorders. We also show that in the setting of diffuse hepatic iron overload, tumefactive extramedullary hematopoiesis appeared isointense to background liver on T2* gradient-echo sequence, while adenoma, hepatoma, and hepatic metastasis appear hyperintense. Thus, T2*-weighted gradient-echo sequence may have a potential role in the imaging diagnosis of mass-forming hepatic extramedullary hematopoiesis arising in the setting of diffuse iron overload.

Evaluation of guided fine needle aspiration cytology in the diagnosis of hepatic lesions

Objectives: To categorize the lesions of liver observed on FNAC into malignant or benign, to correlate the radiological observations with cytology findings and to perform histopathological correlation wherever possible. Material and methods: A total of 150 cases underwent ultrasonography-guided FNAC, in whom lesion/pathology in the liver was suspected and hepatic mass was confirmed on radiological examination with normal prothrombin time. This study was performed on admitted and OPD patients of SRMS IMS, Bareilly from November 2014 to May 2016. Results: Of the total 150 cases, 4 liver aspirates were inadequate for cytological evaluation and were excluded. Most cases (48 cases; 32.87%) were found in the 6 th decade. Radiological findings revealed that out of 146 cases, 6(4.10%) were benign and 140(95.9%) were malignant, while cytological examination revealed 13(8.90%) as benign and 133 (90.09%) as malignant. Among malignant cases, 93.2% were metastatic, the commonest being metastatic adenocarcinoma. Correlation between radiodiagnosis and FNAC was evaluated, which revealed a significant change. Sensitivity and specificity of FNAC were 90.00% and 100% respectively. Accuracy of FNAC was observed to be 90.5% when compared with histopathology; however, the latter was available in very small number of cases. Conclusion: Categorisation of liver lesions into malignant or benign can be done on FNAC with high accuracy. Guided FNAC is very useful in diagnosis of different hepatic lesions as the procedure is simple and safe. The results are obtained quickly without serious complications related to the procedure.

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

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.

Role of fine needle aspiration cytology in the diagnosis of hepatic lesions

Objective: To evaluate the role of Fine needle aspiration cytology(FNAC) as a first line of investigation in space occupying lesions of liver and to study the various cytological patterns in hepatic lesions, categorizing them into non-neoplastic and neoplastic lesions. Materials and Methods: Retrospective study of a total of 138 guided Fine needle aspirations was done at Father Muller Medical College Mangalore, during the period of Jan 2011 to Dec 2013. Papanicolaou (Pap) and May-Grunwald-Giemsa (MGG) stained smears was reviewed and analysed under the microscope. Results: Age ranged from 22 to 85 yrs. 122 out of 138 were conclusive. 17 out of 122 were benign lesions, 8 cases were reported as negative for malignancy, 2 suspicious for malignancy, 95 were malignant cases of which 40 were primary in the liver. Metastatic lesions were 55 including squamous cell carcinoma, adenocarcinoma, malignant melanoma, neuroendocrine and small cell carcinoma. One case of spindle cell neoplasm was reported the histopathology of which was inconclusive. Conclusion : Guided FNA is a first line of investigation in space occupying lesions of liver as the procedure is safe, simple, rapid, effective and minimally invasive.

Proceedings of the meeting “Update in abdominal and uro genital imaging”, Bruges, 6-8 September 2012

Recent advances in hepatic imaging techniques have drawn particular attention to detection and characterization of liver lesions. Optimal imaging diagnosis of hepatic lesions surely depends on the understanding of currently available modalities and its tailored application in consideration of clinical information.

Avaliação dos efeitos da terapia com prednisona em cães utilizando análises ultranossonográfica, citopatológica e histopatológica

Os glicocorticóides são muito utilizados para fins antiinflamatórios e imunossupressores, porém apresentam importantes efeitos colaterais no fígado. O exame ultrassonográfico é um método não-invasivo que avalia a anatomia intra-hepática e possibilita a caracterização de alterações no parênquima decorrentes dos efeitos indesejáveis dos glicocorticóides. O histograma é uma mensuração ultrassonográfica que minimiza a subjetividade do exame, permitindo uma avaliação quantitativa da ecotextura e da ecogenicidade do órgão. Exames citopatológicos e histopatológicos podem auxiliar no diagnóstico de lesões hepáticas induzidas por corticóides. O objetivo deste trabalho foi avaliar os efeitos da terapia com prednisona no fígado de cães por meio de exames citopatológicos, histopatológicos e ultrassonográficos. Para isto, administrou-se em 11 cães adultos prednisona na dose de 2 mg/kg a cada 24 horas durante 14 dias, sendo feita análise ultrassonográfica pela técnica de histograma e coletadas amostras guiada por ultrassom para avaliação citopatológica e histopatológica no primeiro e último dia de administração do medicamento. A partir dessas mensurações pelo histograma, foi possível detectar um significativo aumento da ecogenicidade hepática ao final do protocolo experimental. As análises citopatológicas e histopatológicas demonstraram presença de vacuolização e granulação citoplasmática promovendo um aumento no tamanho dos hepatócitos. Verificou-se que mesmo em curtos períodos e em dosagens terapêuticas, a prednisona promove importantes efeitos colaterais sobre o parênquima hepático.

Image fusion of contrast enhanced ultrasound (CEUS) with computed tomography (CT) or magnetic resonance imaging (MRI) using volume navigation for detection, characterization and planning of therapeutic interventions of liver tumors

To evaluate, whether image fusion of contrast enhanced ultrasound (CEUS) with CT or MRI affects the diagnosis and characterization of liver lesions or the therapeutic strategy of surgical or interventional procedures compared to the preliminary diagnosis. In a retrospective study the image fusion scans of CEUS with contrast enhanced CT or MRI of 100 patients (71 male, mean age 59 years, 0.3-85 years) with benign or malignant liver lesions were evaluated. Fundamental B-scan, color Doppler imaging and CEUS were performed in all patients by an experienced examiner using a multifrequency convex transducer (1-5 MHz, LOGIQ 9/GE) and volume navigation (Vnav). After a bolus injections of up to 2.4 ml SonoVue® (BRACCO, Italy) digital raw data was stored as cine-loops up to 5 min. In 74 patients, CEUS was fused with a pre-existing ceCT, in 26 patients a ceMRI was used. In all 100 patients (100%) the image quality in all modalities (ceCT, ceMRI and CEUS) was excellent or with only minor diagnostic limitations. Regarding the number of lesions revealed in image fusion of CEUS/ceCT/ceMRI and the preceding diagnostic method, concordant results were found in 84 patients. In 12 patients, additional lesions were found using fusion imaging causing subsequently a change of the therapeutical strategy. In 15 out of 21 patients with either concordant or discordant results regarding the number of lesions, image fusion allowed a definite diagnosis due to a continuous documentation of the microcirculation of the tumor and its contrast enhancement. A significant coherency (p < 0.05) among image fusion with either ceCT or ceMRI and CEUS and a subsequent change of therapeutic strategy was found. Image fusion with volume navigation (VNav) of CEUS with ceCT or ceMRI frequently allows a definite localization and diagnosis of hepatic lesions in patients with primary hepatic carcinoma or metastatic diseases. This might cause a change of the therapeutic strategy in many patients with hepatic lesions.

Contrast-enhanced harmonic ultrasound imaging in ablation therapy for primary hepatocellular carcinoma.

The success rate of percutaneous radiofrequency (RF) ablation for hepatocellular carcinoma (HCC) depends on correct targeting via an imaging technique. However, RF electrode insertion is not completely accurate for residual HCC nodules because B-mode ultrasound (US), color Doppler, and power Doppler US findings cannot adequately differentiate between treated and viable residual tumor tissue. Electrode insertion is also difficult when we must identify the true HCC nodule among many large regenerated nodules in cirrhotic liver. Two breakthroughs in the field of US technology, harmonic imaging and the development of second-generation contrast agents, have recently been described and have demonstrated the potential to dramatically broaden the scope of US diagnosis of hepatic lesions. Contrast-enhanced harmonic US imaging with an intravenous contrast agent can evaluate small hypervascular HCC even when B-mode US cannot adequately characterize tumor. Therefore, contrast-enhanced harmonic US can facilitate RF ablation electrode placement in hypervascular HCC, which is poorly depicted by B-mode US. The use of contrast-enhanced harmonic US in ablation therapy for liver cancer is an efficient approach.

The value of standard echography in the diagnosis of hydatic chist

Introduction: The echography represents an important method of diagnosis in hepatology. In the actual time is the method used for the sure diagnosis of hepatic lesions.

Evaluation of FNAC in diagnosis of hepatic lesion

The fine needle aspiration cytology (FNAC) of liver was performed on 90 cases. The diagnostic yield was 83.4%. The main indication of FNAC was hepatomegaly with abnormal ultrsonographic (USG) / computed tomographic (CT) findings. The USG guided FNA was very helpful in making cytological diagnosis of hepatic masses in 90% of cases. Among the hepatic lesions 23.3% were benign, 67.7% were malignant, 6.6% were non-representative and 2.2% were suspicious of malignancy. Metastatic tumours were the most common and constituted 70.4% while the hepatocellular carcinoma accounted for 26.2% of malignant liver lesions.

Fine-needle aspiration biopsy of hepatic lesions

Computerized tomographic (CT)-guided fine-needle aspiration (FNA) cytology is a well-established tool in the diagnosis of hepatic lesions. Endoscopic ultrasound-guided FNA (EUS-FNA), developed recently and used predominantly in evaluating mediastinal and pancreatic lesions, provides access to a significant portion of the liver and to perihepatic structures not readily accessible by a percutaneous approach. A recent experience (1997-2002) with CT-guided FNA of liver lesions at the University of Alabama Birmingham (UAB) was compared with the first 2.5 years of EUS-FNA experience (2000-2002). Cases were identified using a SNOMED search and all reports and cytologic slides were retrieved for review. In 6 years, 34 percutaneous CT-FNA liver biopsies were performed at UAB; in approximately 2.5 years, 16 EUS-FNA liver biopsies were done. In both groups the primary clinical indication was suspected metastatic carcinoma (CT, 41% of cases vs. EUS, 56%). The 2 techniques yielded a similar range of benign, atypical, and malignant diagnoses (CT: 26%, 18%, and 56% vs. EUS: 19%, 25%, and 56%). Because of the clinical setting in which EUS-FNA is usually performed, a much narrower range of neoplasms was sampled by EUS-FNA. Benign gastrointestinal epithelial cells were identified in 60% of the EUS-FNA specimens. Early experience suggests EUS-FNA is comparable to CT-FNA in terms of diagnostic utility for hepatic lesions. Anatomy limits EUS-FNA to only a fraction of the hepatic parenchyma, but that fraction includes the hilum and left lobe of the liver and the proximal biliary tract. The gallbladder, extrahepatic biliary system, and perihilar lymph nodes are readily accessible. Proximate high-resolution ultrasound imaging and cytopathologist involvement in the EUS-FNA process are further advantages. Awareness of artifacts inherent in EUS-FNA sampling (i.e., gut epithelial cells) can minimize a potential diagnostic pitfall.

Diagnosis of hepatic lesions: ultrasonically guided fine needle biopsy or laparoscopy?

We compared the results of ultrasonically guided fine needle aspiration biopsy and laparoscopy in 63 patients who underwent both procedures. In this series, fine needle biopsy showed a sensitivity of 75.6% with a 84.1% overall accuracy. Laparoscopy demonstrated a 74.3% sensitivity with an overall accuracy of 82.7%. The combination of both procedures achieved an overall accuracy of 98.4% with a sensitivity of 97.5%. In one case only (hepatic involvement by Hodgkin's lymphoma), both laparoscopy and ultrasonically guided fine needle biopsy failed to establish the diagnosis. In small and deeply located lesions, ultrasonography is the most useful guide for biopsy. Laparoscopy is irreplaceable in the diagnosis of cirrhosis and in hepatic biopsies requiring larger bore needles. With the increasing use of ultrasonically guided fine needle biopsy, laparoscopy finds new indications, particularly in the preoperative staging of small hepatocellular carcinoma.

Indications for laparoscopy before and after the introduction of ultrasonography

We compared the outcome of laparoscopy performed from 1973 to 1974, prior to the introduction of routine ultrasound diagnostics, with that of examinations during the period 1980-1981 when ultrasound had become a well-established technique in the diagnosis of hepatic lesions. Our data reveal statistically significant changes in the use of laparoscopy in the diagnosis of cholestasis and tumors of the hepatic parenchyma. Laparoscopy now has fewer indications in the study of the jaundiced patient with suspected extrahepatic cholestasis which is easily identified at ultrasound. Given the high sensitivity and specificity of ultrasonography in detecting metastases, laparoscopy has become a secondary examination. However, there has been an increase in the use of laparoscopy to identify benign hepatic lesions, particularly hemangiomas.