Fine-needle Aspiration Diagnosis Research Articles

Transbronchial fine needle aspiration (TBFNA) diagnosis of metastatic pleomorphic sarcoma arising from a dermal sarcoma (MFH) of the scalp

An 82-year-old man underwent investigations for a right perihilar mass in November 2011. He had a previous history of malignant fibrous histiocytoma (pleomorphic sarcoma) of the scalp which was excised in October 2009. TBFNA cytology showed single, multinucleated, large pleo-morphic malignant cells that were positive for Vimentin and CD10. Review of the histology showed a dermal spindle cell tumour displaying morphology reminiscent of an atypical fibrox-anthoma but which was invading the subcutis and abutting the deep fascia. The tumour was CD10+ and negative for cytokeratins, melanocytic and other markers including SMA, CD99 and Desmin. The morphology and immunoprofile was that of a malignant fibrous histiocytoma, as previously reported. There was no lym-phovascular space invasion or perineural invasion. Although peripheral margins were well clear, the clearance from the deep margin was only 0.3 mm. Pleomorphic sarcomas account for a large proportion of sarcomas in late adulthood, with a local recurrence rate of 19–31%, a metastatic rate of 31–35% (lungs 90%) and a 5-year survival of 65–70%. This case highlights the cytological criteria for the diagnosis of pleomorphic sarcoma and also confirms that deeply invasive AFX-like dermal tumours are best classified as pleomorphic sarcomas to better indicate their metastatic potential.

Pitfalls in FNA diagnosis of warthin’s tumour

Aim To illustrate an important potential diagnostic pitfall in salivary gland cytology. In particular, to demonstrate that acinic cell carcinoma can have an appearance indistinguishable from Warthin’s tumour, and should be considered in the differential diagnosis. Methods Corresponding cytology and histology findings are presented for a case of acinic cell carcinoma. Results A 78-year-old male presented with a right parotid swelling. Fine needle aspiration (FNA) showed features typical of a Warthin’s tumour with clusters of oncocytes in a background of small lymphocytes and granular debris. However, histological examination of the excision specimen showed an acinic cell carcinoma invading into surrounding fat and normal parotid. It had very prominent lymphoid stroma with germinal centres. Conclusions Acinic cell carcinomas often have very bland appearing nuclei and may have abundant granular or foamy cytoplasm. These features combined with the prominent lymphoid stroma that may be present in acinic cell carcinomas can easily be misdiagnosed as Warthin’s tumour on FNA and should therefore be considered in the differential diagnosis. It should be remembered that there are numerous neoplastic and non-neoplastic lesions that can give a similar cytological appearance to Warthin’s tumour. FNA results for salivary gland neoplasms should always be interpreted in conjunction with clinical and radiological features.

Fine needle aspiration diagnosis of pulmonary hamartoma

Fine needle aspiration diagnosis of pulmonary hamartoma

Fine needle aspiration diagnosis of Rosai-Dorfman Disease involving thyroid

Rosai-Dorfman disease (RDD), also known as sinus histiocytosis with massive lymphadenopathy is a rare disease involving the lymph nodes. Extranodal RDD involving the thyroid is extremely rare. So far, six cases of RDD involving thyroid have been reported in the literature; all have occurred in females with a mean age of 56.3 years. Clinically, radiologically and cytologically, all the cases were initially diagnosed as thyroid malignancies with lymph nodal metastasis. The final diagnosis was made histologically only after total thyroidectomy. We herein, present a seventh case of RDD involving the thyroid in a 15-year-old female, diagnosed first on fine needle aspiration cytology (FNAC). We conclude that FNAC is a useful diagnostic procedure for RDD involving thyroid; it can avoid an unnecessary thyroidectomy.

Limits of fine-needle aspiration cytology in diagnosing pilomatrixoma: A series of 25 cases with clinico-pathologic correlations

Background:Pilomatrixoma (PMX) is a benign, quite uncommon, skin neoplasm, which is frequently misdiagnosed by clinicians.Aim:We have analyzed 25 PMX to determine the agreement between clinical diagnosis, preoperative FNA characteristics, and corresponding histopathological specimens; moreover, reliable cytologic criteria for PMX and the differential diagnosis to avoid cytological pitfalls have been emphasized.Materials and Methods:By fine-needle aspiration (FNA) cytology a series of consecutive cases of PMX collected during last 5 years were studied. Smears were stained by Papanicolau and May-Grünwald-Giemsa.Results:Patients affected by PMX were 11 males, 14 females (ratio 1:1.27); the mean age was 32.72 years with age range 3-78 years, being 72% (18/25) of patients 40 years or less. PMX was mainly distributed in the head-neck region (52%), scalp (16%), upper/lower arms (28%), and chest (4%). The observed diagnostic cytological features were represented by clusters of basaloid epithelial cells, shadow or ghost cells, inflammatory background, calcification, and giant cells. Unfortunately, not all these morphological aspects were always disclosed in smears, thus making the cytological preoperative diagnosis questionable and problematic.Conclusions:The experience of a well-trained cytopathologist should distinguish the relevant FNA features in terms of smear background, architecture, and cell morphology. The most dangerous mistake in FNA diagnosis of PMX regards a diagnosis of primary malignant or metastatic cutaneous lesions.

The Predictive Value of the Fine-Needle Aspiration Diagnosis “Suspicious for a Follicular Neoplasm, Hürthle Cell Type” in Patients With Hashimoto Thyroiditis

The Predictive Value of the Fine-Needle Aspiration Diagnosis “Suspicious for a Follicular Neoplasm, Hürthle Cell Type” in Patients With Hashimoto Thyroiditis

The application of immunocytochemistry to cytologic direct smears of metastatic merkel cell carcinoma

Merkel cell carcinoma represents a highly aggressive cutaneous malignancy characterized by regional recurrences, lymph node metastases, distant metastases, and high mortality. As the cytomorphology of Merkel cell carcinoma can be mimicked by other malignancies, especially lymphoma and pulmonary small cell carcinoma, immunocytochemistry is often useful in confirming the diagnosis. Cell blocks, which are traditionally utilized for immunocytochemistry, occasionally exhibit insufficient cellularity. Hence, we prospectively investigated the application of CK20 immunocytochemistry to air-dried, unstained direct smears in the diagnosis of Merkel cell carcinoma fine needle aspirates (FNAs). Eight consecutive FNAs of Merkel cell carcinoma were prospectively examined in this series; seven (88%) cases exhibited immunoreactivity for CK20 in the tumor cells. The one CK20-negative Merkel cell carcinoma was immunoreactive for synaptophysin and CD56. This immunophenotype was identical to that of the original primary tumor. For comparison, air-dried direct smears prepared from three pulmonary small cell carcinoma FNAs were examined by CK20 immunocytochemistry. In all cases, no CK20 immunoreactivity was seen in any of the tumor cells. In conclusion, direct smears represent a feasible and robust source of cellular material for immunocytochemical studies to diagnose Merkel cell carcinoma. This methodology allows the cytologist to confirm on site that material for diagnostic immunocytochemistry is present thereby serving as a safeguard in instances where insufficient cell block cellularity is anticipated or encountered.

Application of Magnetic-Resonance-Spectroscopy- Based Metabolomics to the Fine-Needle Aspiration Diagnosis of Papillary Thyroid Carcinoma

Objective: This study explores the potential use of high-resolution magic angle spinning proton magnetic resonance spectroscopy as an ancillary diagnostic technique for papillary thyroid carcinoma in thyroid fine-needle aspiration biopsies. The method has already been shown to be effective in the classification of various other nonthyroid cancers. Study Design: Twenty-six samples (13 paired cytologic and histologic samples) from patients being evaluated for thyroid abnormalities at the Massachusetts General Hospital were spectroscopically analyzed, and included: papillary thyroid carcinomas (n = 4), follicular adenomas (n = 4), and normal thyroid samples (n = 5). Metabolic profiles were statistically generated based on the spectroscopy results, which were then correlated with the final cytologic and histologic diagnoses from the same samples to determine the diagnostic capacity of the profiles. Results: Principal component analysis of the tissue samples revealed statistically significant correlations among principal components and various cytologic and histologic features. Canonical score 1, calculated with principal components in correlation with analyzed pathologies, revealed the ability of the metabolic profile to differentiate all three examined histologic tissue groups (ANOVA, p < 0.0001). Applying coefficients of principal components and canonical scores obtained with tissue samples directly onto spectral results of cytology samples, the calculated canonical score 1 also revealed similar trends among the three fine-needle aspiration biopsy groups. In particular, the papillary thyroid carcinoma group exhibited significant differences from both the adenomatous and normal cytology groups (p < 0.0170). Conclusions: The results indicate the potential of high-resolution magic angle spinning proton magnetic resonance spectroscopy as an ancillary marker for papillary thyroid carcinoma in fine-needle aspiration biopsy specimens.

Use of Samples From Endoscopic Ultrasound–Guided 19-Gauge Fine-Needle Aspiration in Diagnosis of Autoimmune Pancreatitis

Histologic techniques are used to distinguish autoimmune pancreatitis (AIP) from pancreatic malignancies and to confirm the etiology of pancreatitis. Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a well-established technique used in the diagnosis of pancreatic cancer. However, it is unclear whether specimens obtained from pancreatic lesions by EUS-FNA are adequate for the histologic diagnosis of AIP, because the evaluation of tissue architecture and immunostaining assays usually require larger samples. We evaluated samples collected by EUS-FNA with a conventional 19-gauge needle by histologic analysis, looking for features of AIP. We analyzed data from 44 patients who were diagnosed with AIP and underwent EUS-FNA with a 19-gauge needle from January 2004 to September 2010. The FNA specimens were reviewed by histologic analysis; AIP was diagnosed based on the presence of lymphoplasmacytic sclerosing pancreatitis or immunoglobulin (Ig)G4-positive plasma cells in the infiltrate. The specimen amount was inadequate from 3 patients. Among the remaining 41 patients, histopathologic analysis revealed lymphoplasmacytic sclerosing pancreatitis in 17 samples and IgG4-positive plasma cells in 5 (3 samples were positive for both); no samples had granulocytic epithelial lesions. Therefore, 19 patients (43%) were diagnosed with AIP based on histologic analysis. One patient had temporary abdominal pain. EUS-FNA, with a 19-gauge needle, is a safe and reliable procedure for obtaining pancreatic samples for the histologic analysis of AIP. Although it does not have a high diagnostic yield, it might be useful in patients without typical features of AIP because it would allow patients to avoid surgery.

Telecytopathology for Rapid Preliminary Diagnosis of Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules

Onsite evaluation of ultrasound-guided fine-needle aspiration (USGFNA) of thyroid nodules is essential to procure adequate samples and provide initial assessment. We present our experience with onsite evaluation of USGFNA of thyroid nodules using telecytopathology. Real-time images of Diff-Quik-stained cytology smears were obtained with an Olympus Digital camera attached to an Olympus CX41 microscope and transmitted via ethernet by a cytotechnologist to a pathologist who rendered a preliminary diagnosis while communicating with an onsite cytotechnologist over the phone. Accuracy of preliminary diagnosis was compared with final diagnosis, retrospectively. A total of 79 patients (mean age 48.9 year) underwent USGFNA of 100 thyroid nodules. Preliminary diagnoses of benign, suspicious/malignant, and unsatisfactory were 72%, 7%, and 21%, respectively. Of the 72 cases initially reported as benign all remained benign on the final cytology. Of the seven suspicious/malignant cases on initial cytology, five were suspicious/malignant and two were benign on final cytology. Of the 21 cases that were initially interpreted as unsatisfactory only four were reclassified as benign on final diagnosis. The accuracy rate between the final cytology and preliminary telecytopathology diagnosis was 94%. Presence of additional material on Papanicolaou-stained slides and cellblock sections was the main reason for discrepancy that accounted for six discrepant cases. On-site telecytopathology for thyroid USGFNAs is highly accurate compared with final cytologic evaluation. It allows pathologists to use their time more efficiently and makes onsite evaluation at a remote site possible.

Fine‐needle aspiration cytology of abdominal wall endometriosis

While about 15% of menstruating women develop endometriosis, abdominal wall endometriosis is relatively rare. We present 10 cases of abdominal wall endometriosis diagnosed by fine-needle aspiration (FNA) cytology and confirmed by subsequent surgical excision. A palpable abdominal wall mass was the most common symptom, followed by pain. Nine cases were associated with previous surgery. The smear showed glandular epithelial cells and spindle or ovoid stromal cells accompanied by macrophages in eight cases. The nucleus was round-to-oval and the nucleolus was inconspicuous. Mitosis was not observed in any case. In two cases, which were suspicious of malignancy on FNA, the epithelial cells showed anisonucleosis, hyperchromasia, and small conspicuous nucleoli. The stromal cells were spindle or ovoid in shape, without metaplastic changes. Histiocytes were noted in nine cases and hemosiderin-laden histiocytes were noted in two cases. The proportion of inflammatory cells varied. FNA diagnosis of abdominal wall endometriosis is possible when the cytological features are interpreted cautiously, together with the patient's clinical history. An accurate diagnosis on FNA will prevent unnecessary surgery.

Citologia aspirativa no diagnóstico da linfadenite em ovinos

O presente estudo investigou o uso da cito-(73,0%), Arcanobacterium pyogenes (6,0%), Streptococlogia aspirativa com agulha fina no diagnóstico da lin-cus spp. β hemolítico (5,0%) e Escherichia coli (4,0%) fadenite em ovinos e a ocorrência de microrganismos foram os microrganismos mais frequentes nos animais nos linfonodos com lesões, com ênfase no isolamento de com linfadenite. Streptococcus spp. (21,0%) e Staphylo-Corynebacterium pseudotuberculosis. Foram utilizados coccus spp. (7,0%) foram as bactérias isoladas com 100 linfonodos de ovinos com aumento de volume su-maior frequência nos linfonodos sem lesões colhidos em gestivos de linfadenite e 100 linfonodos de ovinos sem abatedouro. A punção aspirativa com agulha fina perlesões, colhidos em abatedouro. C. pseudotuberculosis mitiu identificar microrganismos "corineformes" em 79 (79,0%) animais com linfadenite e, destes, 73 (73,0%) foram identificados como C. pseudotuberculosis. Nenhuma linhagem de C. pseudotuberculosis foi isolada dos linfonodos dos animais sem lesões. Concluiu-se que C. pseudotuberculosis foi o microrganismo mais freqüente nos ovinos com linfadenite, e que a citologia aspirativa pode ser utilizada como método de triagem no diagnóstico da linfadenite caseosa ovina

Intrapancreatic Accessory Spleen: The Role of Endoscopic Ultrasound-Guided Fine Needle-Aspiration for Diagnosis

Intrapancreatic Accessory Spleen: The Role of Endoscopic Ultrasound-Guided Fine Needle-Aspiration for Diagnosis

Multicentric encapsulated papillary oncocytic neoplasm of the thyroid: A case diagnosed by a combined cytological, histological, immunohistochemical, and molecular approach

Fine-needle aspiration (FNA) diagnosis of oncocytic lesions is challenging. In fact, oncocytic changes occur in inflammatory, hyperplastic, and neoplastic settings, including both benign and malignant tumors. The rare oncocytic variant of papillary thyroid carcinoma (PTC), shows papillae composed by cells with large oncocytic granular cytoplasm featuring clear PTC nuclear features. A morphological similar, but biologically distinct lesion, is the encapsulated papillary oncocytic neoplasia. Here, we first report on FNA, its cytological features together with histological, immunohistochemical, and molecular correlates.

Endoscopic ultrasound-guided fine needle aspiration for diagnosis of lesions of gastrointestinal tract and adjacent organs

Objective To evaluate the role of endoscopic ultrasound-guided fine needle aspiration （EUS-FNA） for diagnosing lesions of gastrointestinal tract and the nearby organs. Methods Clinical and pathological data of 161 EUS-FNA lesions in 133 consecutive patients were retrospectively analyzed. Resuits Of the 161 lesions, there were 142 solid lesions, 15 cystic lesions and 4 pancreatic solid-cystic lesions. EUS-FNA was performed at lesions of upper gastrointestinal tract, rectum and anal canal. 160 cytologic diagnoses （99. 4% ） were obtained in all 161 lesions. 143 histological diagnoses （97. 9% ） and 113 immunohistologieal diagnoses （77. 4% ） were obtained in 146 solid lesions （including 4 pancreatic solid-cystic ones）. Diagnosis rates of samples for immunohistology remained similar between 22-gauge and 19-gauge needles and also similar among different sites （ P 〉 0. 05 ）. But immunohistological diagnosis rate of smaller lesions （ 〈 1 cm） was lower than that of bigger ones （ 〉tl cm） （P 〈0.05）. The diagnosis rates of cytology,histology and pathology in solid lesions were 81.2% （ 120/146）, 82. 9% （121/146） and 89. 7% （ 131/ 146 ）, respectively. Size of needles and lesion location did not exert influence on diagnosis, but the diagnosis rate of smaller lesions （ 〈 1 cm） was lower than that of bigger ones （ 〉11 cm）. Cytological diagnosis was consistent with histological diagnosis （ x = 1. 0, P = 0. 00）, 11 cases that could not be diagnosed by cytology was confirmed by histology and 10 eases that could not diagnosed by histology was confirmed by cytology. There were no complications during the procedures. Conclusion EUS-FNA is a valuable diagnostic tool for lesions of gastrointestinal tract and nearby organs. The needle size and lesion site were not influential factors for diagnosis. Smaller lesions （ 〈 1 cm） yielded lower diagnosis rate than bigger ones （ 〉11 cm）. The cytologic diagnosis combined with histology can improve the diagnostic value of EUS-FNA. Key words: Endoscopic uhrasonography ; Neoplasma; Fine-needle aspiration

Ultrasound-guided fine needle aspiration diagnosis of supraglottic laryngeal cancer

Although intraoperative laryngoscopic examination and biopsy of patients who present with locally advanced supraglottic carcinomas remains the standard of care, there are occasions when a more expedited biopsy can be helpful. We describe a quick diagnostic technique of ultrasound-guided fine needle aspiration of endolaryngeal advanced supraglottic carcinomas, which can be performed in the clinic without any preparation. Ultrasound scanning is performed through the thyrohyoid membrane. The tumor is visualized as an irregular hypoechoic mass. While continuing to visualize the mass, a 21-gange needle attached to a syringe is passed through the contralateral thyrohyoid membrane into the mass. Suction is applied, and the aspirate is sent for cytologic study. When formal intraoperative laryngoscopy and biopsy is not feasible or timely, ultrasound-guided fine-needle aspiration biopsy enables a rapid diagnosis and eliminates the cost, side effects, and risks of a direct laryngoscopy.

Diagnostic and prognostic information obtained on fine‐needle aspirates of primary neuroblastic tumors

The use of cytological material for diagnosis and prognosis in patients with neuroblastic tumors is poorly described in the literature. A total of 129 patients with primary neuroblastic tumors underwent sampling with fine-needle aspiration for diagnosis and the evaluation of prognostic parameters. Of these, 125 (97%) were neuroblastomas or ganglioneuroblastomas and 4 (3%) were ganglioneuromas. Cellularity of the smears was assessed, as well as the percentage of neuroblasts versus stroma, maturation (differentiating/mature vs immature cells), the mitosis-karyorrhexis index (MKI), and the number of Homer Wright rosettes. The cytology samples were also analyzed for MYCN amplification, flow cytometric DNA index, and array comparative genomic hybridization. MYCN was found to be amplified in 35 (27%) cases. Strong correlations with overall survival were found for MYCN amplification in localized stages including IVs (P < .001), the percentage of neuroblasts versus stroma (P < .001), maturation (P = .002), MKI (P < .001), and DNA index (P < .03). Poorly differentiated tumors with few stromal components and low numbers of differentiating/mature cells were found to be MYCN amplified. The authors propose a "cytology prognostic score" in which neuroblastomas comprised of predominantly neuroblastic elements with no differentiating cells and an MKI >; 2% are classified as high-risk tumors, regardless of their MYCN amplification status. The use of this proposed score would ensure accurate and optimal diagnostic and prognostic classifications of neuroblastic tumors in cases in which the histological biopsy is absent or inadequate for analysis.

Fine needle aspiration biopsy of hepatocellular carcinoma and hepatocellular nodular lesions: role, controversies and approach to diagnosis

The role of fine needle aspiration (FNA) biopsy of the liver has evolved. Advances in imaging modalities have obviated the need for tissue confirmation in clinically classic hepatocellular carcinoma (HCC). The risks of needle tract seeding and haematogenous dissemination have been actively debated. Nowadays, cytopathologists are confronted by smaller and smaller nodules, detected due to increased surveillance of high-risk cirrhotic patients. Tissue characterization of small well-differentiated hepatocellular nodular lesions (size less than and equal to 2 cm) is extremely challenging and has therapeutic implications. Major issues in the cytodiagnosis of HCC include: (i) distinguishing benign hepatocellular nodular lesions, namely, large regenerative nodules, dysplastic nodules, focal nodular hyperplasia and hepatocellular adenoma from reactive hepatocytes; (ii) distinguishing well-differentiated HCC from benign hepatocellular nodular lesions; (iii) distinguishing poorly differentiated HCC from intrahepatic cholangiocarcinoma and metastatic carcinomas; (iv) determining the histogenesis of a malignant tumour; and (v) determining the site of origin of a malignant tumour. An overview of the biological evolution and histopathological aspects of dysplastic nodules, small HCCs and 'nodule-in-nodule' lesions is presented in tandem with clinically relevant nomenclature. An algorithmic approach to FNA diagnosis of HCC and hepatocellular nodular lesions is outlined. Optimal results depend on (i) a dedicated radiologist-cytopathologist team; (ii) an on-site cytology service, (iii) a combined cytohistological approach, (iv) immunohistochemistry, and (v) clinicopathological correlation. As we move towards personalized medicine, it is envisaged that hepatic FNA is likely to become a point of care in the management protocol as it takes on the additional role of procurement of tumour and peritumoural tissues for genomic and proteomic profiling to enable targeted molecular therapy.

The impact of implementation of the Bethesda System for Reporting Thyroid Cytopathology on the quality of reporting, “risk” of malignancy, surgical rate, and rate of frozen sections requested for thyroid lesions

The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) has been anticipated to improve communication between pathologists and clinicians and thereby patient outcomes. In the current study, the impact of TBSRTC on various quality and outcome measures was assessed. The current study included all patients who underwent fine-needle aspiration (FNA) of the thyroid between April 2006 and April 2009. Before implementation, the authors used generic diagnostic categories; after implementation, TBSRTC was used. Quality of reporting, diagnostic categories, rate of surgery, rates of frozen section, the "risk" of malignancy after a cytologic diagnosis, and errors before and after implementation of TBSRTC were compared using the chi-square and Fisher exact tests. Multilevel likelihood ratios and the receiver operating characteristic were used to compare the accuracy of FNA before and after implementation. A total of 1671 FNAs (957 obtained before and 714 obtained after implementation of TBSRTC) were obtained from 1339 patients. Of these, 301 patients (191 before and 110 after implementation) underwent subsequent surgical resection. Before implementation, the reports were more ambiguous (3.7% vs 0.5%; P < .05) and implicit (5.1% vs 2.7%; P < .05) than after implementation. The overall rate of surgery decreased after implementation of TBSRTC (24.5% vs 19.6%; P < .05). The overall risk of malignancy did not appear to be affected by implementation of TBSRTC, but it decreased significantly after a benign FNA diagnosis compared with a diagnosis of an atypical lesion or follicular neoplasm. The rate of frozen section remained unchanged. The diagnostic accuracy was not found to be significantly different before compared with after implementation of TBSRTC. Implementation of TBSRTC appears to improve the quality of reporting by lowering the number of ambiguous and implicit diagnoses and decreases the overall surgery rates, particularly for benign lesions, but it does not appear to have any effect on the accuracy of FNA of the thyroid, false-positive rates, or the frequency of intraoperative consultations.

Fine-Needle Aspiration Biopsy of Hepatocellular Carcinoma and Related Hepatocellular Nodular Lesions in Cirrhosis: Controversies, Challenges, and Expectations

The role of hepatic fine-needle aspiration (FNA) biopsy has evolved. Advances in imaging modalities have obviated the need for tissue confirmation in most hepatocellular carcinomas (HCCs). There is risk of needle-tract seeding. Increasingly, small nodules are being detected on ultrasound surveillance of high-risk patients. Diagnostic challenges associated with cirrhosis include distinction of benign hepatocellular nodules, namely, large regenerative nodules and dysplastic nodules, from reactive hepatocytes; and distinction of well-differentiated HCCs from benign hepatocellular nodules. This paper will discuss (i) controversies regarding preoperative/pretransplantation FNA diagnosis of HCC, (ii) update of biological evolution, nomenclature, and histopathologic criteria for diagnosis of precancerous nodules and small HCCs, and (iii) algorithmic approach to FNA diagnosis of hepatocellular nodules. Optimal results depend on dedicated radiologist-cytopathologist team, on-site cytology service; combined cytohistologic approach, immunohistochemistry, and clinicopathologic correlation. Hepatic FNA is likely to be incorporated as a point of care as we move towards personalized medicine.