Primary culture of aspiration residual specimens improves the diagnostic accuracy between hepatocellular carcinoma and benign nodules

Results of fine-needle aspiration of hepatic nodules may be equivocal to confuse clinical judgment. The utility of primary culture of aspiration residual specimens to improve the accuracy in differential diagnosis between hepatocellular carcinoma and benign lesions was investigated. A total of 337 patients (hepatocellular carcinoma proven by aspiration 277, by other modalities 35, benign nodules 25) were included. The growth patterns of cancer cells at the 14th day of primary culture from aspiration proven hepatocellular carcinoma patients were applied as criteria for analysis. Hepatocellular carcinoma proven by aspiration showed higher incidence of outgrowth of cancer cells than those not proven by aspiration or the incidence of outgrowth of hepatocyte antigen positive cells in benign lesions (all P < .02). To differentiate hepatocellular carcinoma from benign nodules measuring <= 2 cm, growth patterns as item showed similar sensitivity and accuracy to aspiration results. The negative predictive values for the above two items in differential diagnosis were all below 45% in nodules measuring either <= or >2 cm. Using at least one positive result of growth patterns or aspiration as item for differential diagnosis increased the sensitivity, negative predictive value and accuracy, but little decreased the specificity and positive predictive value as compared with aspiration results alone in nodules measuring either <= or >2 cm. In conclusion, the growth patterns at the 14th day of primary culture can be applied for dynamic interpretation of the specimens to improve the diagnostic accuracy of fine-needle aspiration between hepatocellular carcinoma and benign lesions.