Karaciğer Kitlelerinin Değerlendirilmesinde Ultrasonografi Eşliğinde Yapılan İnce İğne Aspirasyon Biopsisi: Sitoloji Ve Mikrohistolojinin Tanısal Değeri

Year 2007, Volume: 4 Issue: 1, 16 - 23, 01.04.2007

Z Füsun Baba Yeşim Sağlıcan İşın Pak

Abstract

Ankara Onkoloji Hastanesi’nde Ocak 1992-Temmuz 1996 tarihleri arasında karaciğerinde kitle bulunan 107 olguya tanı amaçlı ultrasonografi USG eşliğinde ince iğne aspirasyon biopsisi İİAB uygulanmış, girişim sırasında elde edilen aspirat içerisindeki küçük doku fragmanları da rutin takibe alınarak her olgu için ayrıca mikrohistolojik preparat elde edilmiştir.Olguların önce sitolojik, daha sonra da mikrohistolojik preparatları incelenmiş, ve iki yöntemin önce ayrı ayrı, sonra da kombine edildiğinde karaciğer kitlelerinin tanısındaki güvenilirliği araştırılmış, spesifik tanı vermedeki başarıları belirlenmiştir. Sitolojik ve mikrohistolojik yöntemler birarada kullanıldıklarında sensitivite, spesifisite, ve genel doğruluk oranlarının % 100’e çıktığı görülmüştür. Sitolojiye mikrohistoloji de eklendiğinde bu yöntemin değeri daha da artmaktadır.Yanlızca malign-benign lezyonları ayırmakla kalmayıp uygun klinikopatolojik ve radyolojik korelasyon sağlandığında lezyonun tipini kesin olarak saptayıp hastanın daha ileri tedavi protokolünü belirlemekte ve prognozu hakkında da önemli bilgiler vermektedir

Keywords

İnce iğne aspirasyon biopsisi, mikrohistoloji, karaciğer kitlesi

Ultrasound-Guided Fine Needle Aspiration Biopsy İn The Evaluation Of Liver Masses: Diagnostic Value Of Cytology And Microhistology

Abstract

Between January 1992 and July 1996 ,107 patients with liver masses who underwent diagnostical ultrasound guided fine needle aspiration biopsy in Ankara Oncology Hospital were collected for this study. Besides cytologic preparations, the small tissue fragments that were collected during aspiration biopsy were processed and microhistologic sections were obtained. First cytologic, then microhistologic slides of patients were evaluated and these two diagnostic methods were compared first separately, and then combinedly for their sensitivity, specificity and diagnostic accuracy in the final diagnosis of liver masses. When these two diagnostical methods were combined, the mentioned parameters were found to be 100%. These two methods, when used together, not only specify between malignant and benign lesions, but also state the correct histological diagnosis and thus predict the diagnosis and specify the type of the therapy for patients

Keywords

Fine needle aspiration biopsy, microhistology, liver masses

References

• Nguyen G.K. Fine needle aspiration cytology of hepatic tumors in adults. Pathol Annu 1986; 2:321-349.
• Bognel C., Rougler P., Leclere J. et al. Fine needle aspiration of the liver and pancreas with ultrasound guidance. Acta Cytol 1988; 32(1):22-26.
• Droese M., Altmannsberger M., Kehl A. percutaneous fine needle aspiration biopsy ratroperitoneal masses. Accuracy of cytology malignancy, cytologic tumor typing and use of antibodies to intermediate filaments in selected cases. Acta Cytol 1984; 28(4):368-384. guided of abdominal and in the diagnosis
• of Fernandez M.P., Murphy F.B.. Hepatic biopsies and fluid drainages. Radiol Clin N Am 1991; 29(6): 1311-1327.
• Frable W.J. Fine needle aspiration biopsy: a review. Hum Pathol 1983; 14(1):9-28.
• Frable W.J. Needle aspiration biopsy: Past, present, and future. Hum Pathol 1989; 20(6):504-517.
• Fornari F., Civardi G., Cavanna L. Et al. Ultrasonically guided fine needle aspiration biopsy: A highly diagnostic procedure for hepatic tumors. Am J Gastroenterol 1990; 85(8):1009-1013.
• Schaff Z. Liver. İn: Henson H., Saavedra A. (eds.) Major problems in pathology.(vol:28)
• Company,Philadelphia 1993;151-166. 9. Houn H.Y., Sanders M.M., Walker E. Et al. Fine needle aspiration in the diagnosis of liver neoplasms: A review. Ann Clin Lab Sci 1991; 21(1):2.
• Jacobsen G.K., Gammelgaard J., Fuglo M. Coarse needle biopsy versus fine needle aspiration biopsy in the diagnosis of focal lesions of the liver.Ultrasonically biopsy malignancy. 27(2):152-156.
• Pilotti S., Rilke F., Claren R. Et al. Conclusive diagnosis of hepatic and pancreatic malignancies by fine needle aspiration. Acta Cytol 1988; 32(1):22- 26.
• Pinto M.M., Avila N.A., Heller C.I. et al. Fine needle aspiration of the liver. Acta Cytol 1988; 32(1):15-21.
• Sbolli G., Fornari F., Civardi G. Et al. Role of ultrasound guided fine needle aspiration biopsy in the diagnosis of hepatocellular carcinoma. Gut 1990; 31:1303-1305.
• Saul S.H. Masses of the liver. İn: Sternberg
• Surgical Pathology. 2nd ed. (vol:2) Raven Press, New York, 1994; 1517- 1580.
• Diagnostic 15. Tao L.C.,Donat E.E., Ho C.S. et al. Percutaneous fine needle aspiration biopsy of the liver: Cytodiagnosis of hepatic cancer. Acta Cytol 1979; 23:287-291.
• Tatsuta M., Yamamoto R., Kasugai H. et al. Cytohistologic diagnosis of neoplasms
• ultrasonically guided fine needle aspiration biopsy. Cancer 1984; 54(8):1682-1686. liver
• by 17. WhitlatchS., Nunez C., Pitlik D.A. Fine needle aspiration biopsy of the liver. A study of 102 consecutive cases. Acta Cytol 1984; 28(6):719- 725.
• Berman J.J., McNeill R.E. Cirrhosis with atypia. A potential pitfall in the interpretation of liver aspirates. Acta Cytol 1988; 32(1):11-14.
• Tao L.C. Liver and pancreas .İn: Bibbo Cytopathology.
• Company, Philadelphia, 1991; 822- 841.
• Saunders 20. Hajdu S.I., Melamed M.R. Limitations of aspiration cytology in the diagnosis of primary neoplasms. Acta Cytol 1984; 28(3):337-345. 21. Limberg B., Höpker
• W.W., Kommerell B. Histologic differential diagnosis of focal liver lesions by ultrasonically guided fine needle biopsy.
• Tao L.C., Ho C.S., Mc Loughlin M.J. et
• hepatocellular carcinoma by fine needle aspiration biopsy. Cancer 1984; 53(3):547-552. of Atlas of
• Diagnostic W.B.Saunders immunofluorescence technique. Gastrointest of cystic
• liver 29. Fornari F., Rapaccini G.L., Cavanna L. et al. Diagnosis of hepatic lesions: Ultrasonically guided fine needle biopsy or laparascopy? Gastrointest Endosc 1988; 34:231-234.
• Sangalli G., Livraghi T., Giordano F. Fine needle biopsy of hepatocellular carcinoma: Improvement in diagnosis by microhistology. Gastroenterology 1989; 96(2):524-526.
• Collins V.P., Ivarsson B. Tumor classification by electron microscopy of fine needle aspiration biopsy material. Acta Pathol Microbiol Scand 1981; 89:103-105.
• Johnson D.E., Powers C.N., Rupp G. Et al. Immunocytochemical staining of fine needle aspiration biopsies of the liver as a diagnostic tool for hepatocellular carcinoma. Mod Pathol 1992; 5(2):117-123. 33. Wong M.A., Yazdi
• H.M. versus Hepatocellular carcinoma metastatic to the liver. Value of stains for carcinoembrionic antigen and naphthylamidase in fine needle aspiration biopsy material. Acta Cytol 1990; 34(2):192-196.
• Cochand-Priollet B., Chagnon S., Ferrand J. et al. Comparison of cytologic examination of smears and histologic examination of tissue cores obtained by fine needle aspiration biopsy of the liver. Acta Cytol 1987; 31(4):476-480.
• Koss L.G. Diagnostic Cytology and its Histopathologic Basis. 4th ed. (vol:2) J.B. Lippincott co., Philadelphia, 1992; 1344-1355.
• Perry M.D., Johnston W.W. Needle biopsy of the liver for the diagnosis of nonneoplastic liver diseases. Acta Cytol 1985; 29(3):385-390.
• Rapaccini G.L., Pompili M., Caturelli E. Et al. Ultrasound guided fine needle biopsy of hepatocellular carcinoma: Comparison between smear cytology and Gastroenterol 1994; 89(6):898-902.
• Bell D.A., Carr C.P.,Szyfelbein W.M. Fine needle aspiration cytology of focal liver lesions.Results obtained with examination of both cytologic and histologic preparations. Acta Cytol 1986; 30(4):397-401.
• Rode J. Commentary : Fine needle cytology Histopathology 1989; 15:435-439.
• Glenthoj A.,Sehested M., Torp- Pedersen S. Diagnostic reliability of histological and cytological fine needle biopsies from focal liver lesions. Histopathology 1989; 15:375-383.
• Ojanguren I., Ariza A., Llatjos M. Et al. Proliferating cell nuclear antigen expression in normal, regenerative, and neoplastic liver: A fine needle aspiration cytology and biopsy study. Hum Pathol 1993; 24(8):905-908.
• Ganjei P., Nadji M., Albores-Saavedra J. et al. Histologic markers in primary and liver.Cancer 1988; 62(9):1994-1998.
• Guigui B., Mavier P., Lescs M.C. et al. Copper and copper binding protein in liver 61(6):1155-1158.
• Haratake J., Horie A., Takeda S. Histochemical study of copper binding protein in hepatocellular 1987; 60(6):1269-1274.
• Lai Y.S., Thung S.N., Gerber M.A. et al. Expression of cytokeratins in normal and diseased livers and in primary liver carcinomas. Arch Pathol Lab Med 1988; 113:134-138.
• Cancer 46. Ma C.K., Zarbo R.J., Frierson H.F. et al. Comparative immunohistochemical study of primary and metastatic carcinomas of the liver. Am J Clin Pathol 1993; 99:551-557.
• Malberger E., Edoute Y., Nagler A. Rare transabdominal fine needle aspiration. Am 1984;79(6):458-460. after Journ Gastroenterol