The Significance of On-Site Evaluation of Image-Guided Core Needle Biopsy of Liver Masses
S Williams, S Sahoo, H Alatassi. University of Louisville, Louisville, KY
Background: Image-guided core needle biopsy (CNB) is a safe, rapid and cost-effective procedure for sampling of liver masses. It is extremely important for the radiologist who obtains a core biopsy under ultrasound or CT guidance to accurately place the needle and sample the lesional tissue. Immediate evaluation of touch imprint cytology (TIC) of the core biopsy by a pathologist during the procedure not only ensures the lesion has been sampled, but also minimizes the number of needle punctures.
Design: A retrospective review of all image-guided CNB performed for the evaluation of liver masses over last 5 years was performed. In all cases, a pathologist was available for on-site evaluation of the TIC of the cores to assess sample adequacy. The aim of the study was to evaluate the impact of providing rapid interpretation in reducing the number of passes required before obtaining diagnostic material.
Results: Of the 70 CNB of liver masses, 54 were malignant (50 metastases and 5 hepatocellular carcinoma) and 13 were benign lesions (1 focal nodular hyperplasia, 5 cirrhotic nodules and 7 cases with non-specific findings). Three cases that were interpreted as inadequate on TIC remained inadequate on the final interpretation. Specimen adequacy was correctly interpreted 69 of 70 cases (99%): on the first pass in 51 cases (72%), on the second in 13 cases (19 %) and on the third in 6 cases (9%). Only in one case, the pathologist was unable to accurately diagnose the malignancy on TIC. In 3 cases, the immediate evaluation was that of a lymphoid malignancy which led to allocating part of the sample for flow cytometry.
Conclusions: Touch imprint cytology is very sensitive for evaluating specimen adequacy of CNB. Immediate evaluation of CNB prevented unnecessary passes in vast majority of cases and facilitated triaging the specimen for further testing.
Category: Liver & Pancreas
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 165, Tuesday Morning