Necessity and Safety of Fine-needle Aspiration Cytology for Diagnosis of Hepatocellular Carcinoma

B ackg roun ds/ A im s : T he fineneedle aspiration (FNA ) is a useful method for diagnosis of hepatocellular carcinoma (HCC). T he aims of our study are to assess diagnostic accuracy of FNA, to define proper indications of FNA for diagnosis of HCC, and to evaluate the complications of FNA. S ubject s an d M ethods : T o assess diagnostic accuracy we compared the result s of preoperative FNA with postoperative pathology in 38 resected cases with primary liver cancer . T o define proper indications and complication s of FNA, we prospectively followed 138 patients received FNA for their liver tumors which were suspicious of primary liver tumor . Re sult s : T he sensitivity , specificity , positive and negative predictive values of FNA were 100%, 97%, 100% and 66% respectively. All patient s with serum alphafetoprotein (AFP) level over 1000 ng/ ml w ere having HCC on FNA result . Among 36 patient s with AFP level ranged 151000 ng/ ml and hypervascular mass on angiography, 96% w ere having HCC. Among 50 patients with normal AFP level and hypervascular mass on angiography , 92% were having HCC. T he major complications after FNA such as hemoperitoneum, pneumothorax , and iatrogenic arterioportal shunt developed in 2%, 2%, and 7% of subjects , respectively. We did not find any case of needletract seeding of cancer during a mean 4.7 months of follow up. Conclu s ion s : Although the FNA is an accurate method for diagnosis of HCC, FNA w as usually not indicated for patient s with serum AFP level over 1000 ng/ ml or patient s with hypervascular mass on angiography when they were suspected of having primary liver cancer . Major complications were hemoperitoneum, pneumothorax and iatrogenic arterioportal shunt . Iatrogenic arterioportal shunt may influence the efficacy of subsequent transcatheter arterial embolization .. (Korean J H epatol 2000 ;6 :505 513 )