Ultrasonically-guided needle aspiration with preparation of cell blocks in the diagnosis of liver tumors

To evaluate the diagnostic value of a method combining ultrasonically-guided Chiba needle aspiration and histological block preparation of aspiration specimen, 50 consecutive patients with histologically confirmed focal or diffuse lesion of the liver were studied. In addition to conventional aspiration cytology, the aspiration specimen was mixed 1:1 by volume with 95% alcohol and centrifuged. The precipitated specimen was then embedded in paraplast. Serial sections were obtained and stained with hematoxylin and eosin (H and E) technique. The diagnostic specificity and positive predictive value of the cell block technique in diagnosing hepatic malignancies were both 100%, as was those of aspiration cytology. The diagnostic sensitivity and overall accuracy of cell blocks were significantly better than those of aspiration cytology (89.5% vs. 63.2%, P < 0.01; and 92.0% vs. 72.0%, P < 0.01). The negative predictive value of cell blocks was also better than that of aspiration cytology, but the difference was not statistically significant (75.0% vs. 46.2%, P > 0.05). In terms of cellular differentiation, the accuracy of the diagnosis of cell blocks was 78.6% (22/28) in hepatoma; 80.0% (4/5) in metastatic adenocarcinoma and 100.0% (1/1) in small cell carcinoma. No complications were encountered in any of the patients. The results suggest that the preparation of cell blocks of the aspiration specimen is a reliable and accurate method for the diagnosis of hepatic malignancies. This method also elevates the diagnosis of the aspiration specimen from the cytological to the histopathological level.