Cellular interpretation of hepatocellular carcinoma by using cell blocks technique

Background/Aims: The purpose of this study was to investigate the cellular interpretation of hepatocellular carcinoma in specimens obtained by needle aspiration with preparation of cell blocks. Methodology: We consecutively collected 58 patients who were histologically proved to have hepatocellular carcinoma. Corresponding to the size of hepatocellular carcinoma, the cellular dysplasia of specimens obtained by both aspirations with cell blocks and conventional liver biopsy from each hepatocellular carcinoma was investigated according to Edmondson-Steiner's grading (Gr). Results: Of 16 small hepatocellular carcinomas (diameter <3.0cm), the occurrence rate of dysplasic grading of Gr-I, Gr-II, Gr-III and Gr-IV was 31.3%, 43.8%, 18.8% and 6.3% in aspiration with cell blocks, and 46.2%, 38.5%, 15.4% and 0.0% in liver biopsy respectively. There was no Gr-I of cellular dysplasia in the 15 moderate size (3.1-6.0cm) and 27 large size (> 6.1cm) hepatocellular carcinomas. The occurrence rate of Gr-III cellular dysplasia in small hepatocellular carcinoma was lower than that in large hepatocellular carcinoma (18.8% vs. 55.6%, p=0.019). The larger the tumor is, the more poorly differentiated it became. Four of six histologic false-negative hepatocellular carcinoma in aspiration with cell blocks were large size hepatocellular carcinoma (>6.5cm in diameter) with necrosis. Conclusions: These results suggest that the interpretation of the cell grading of hepatocellular carcinoma by aspiration with cell blocks is not inferior to that by conventional liver biopsy. This technique seems to provide another route to study the cellular dysplasia of hepatocellular carcinoma in living patients even to follow-up their treatment response.