Cytological Evaluation of Space-Occupying Lesions of the Liver by Fine Needle Aspiration.

Introduction  Malignant space-occupying lesions (SOLs) of the liver, particularly hepatocellular carcinoma, are more common in developing countries such as China and India due to cirrhosis, hepatitis B and C, haemochromatosis, and emerging metabolic risk factors. The aim and objective of the study was to evaluate the cytological spectrum and diagnostic yield of USG-guided fine-needle aspiration cytology (FNAC) in SOLs of the liver. Specifically, it focused on differentiating benign from malignant lesions, distinguishing primary hepatic malignancies from secondary (metastatic) tumours, and establishing a cytological diagnosis in cases of SOLs of the liver. Methods Fifty-seven patients with a clinical history suggestive of SOLs in the liver on ultrasound imaging, and for whom FNAC was advised by the clinician, were included in the study. Aspirates were taken, and smears were prepared as soon as possible in the laboratory. Air-dried smears were stained with May-Grünwald-Giemsa, while wet-fixed smears were processed for Papanicolaou and haematoxylin-eosin staining. The stained smears were studied for cytomorphology to establish the diagnosis. Results  During the study period, a total of 57 patients who reported for aspiration of liver SOLs and met the inclusion criteria were included in the study. The mean age at presentation of liver SOLs was 52.2 years, with ages ranging from 24 to 75 years. The most common age group for malignant lesions was 40-60 years, with a male predominance; the male-to-female ratio was 2.4:1. The liver lesions were cytologically classified as non-neoplastic (10 cases, 17.54%), neoplastic (44 cases, 77.19%), and non-diagnostic (3 cases, 5.26%). The commonest malignancy in our study was hepatocellular carcinoma, which accounted for 24 cases (54.54%), followed by metastatic adenocarcinoma in 16 cases (36.36%) and unclassified carcinoma in 4 cases (9.09%). Conclusion  This study demonstrates that FNAC enables the early and accurate diagnosis of liver SOLs in resource-limited hospitals, thereby reducing associated morbidity and mortality.