Diagnostic value and complications of fine needle aspiration for primary liver cancer and its influence on the treatment outcome - A study based on 3011 patients in China

Aim: To determine the diagnostic value and major complications of fine-needle aspiration (FNA) for primary liver cancer (PLC) and its influence on the treatment outcome and prognosis. Methods: Information was gathered retrospectively for 3011 patients who presented with suspected PLC. Of which 2528 cases underwent ultrasound-guided fine-needle aspiration (US-FNA) biopsy. Patients were followed up through repeated office visits and imaging studies with a median follow-up of 7 months (range, 1-29 months). Results: The sensitivity, specificity, positive predictive value, negative predictive value and overall accuracy of cytological diagnosis by FNA biopsy for detection of liver malignancy were 91.5%, 100.0%, 100.00%, 59.1% and 92.4% respectively. All patients with AFP >= 400 mu g/L were associated with malignancy. Of 1154 patients with AFP < 400 mu g/L who were finally proved PLC, 945 were detected by FNA alone. Major complications included bleeding in I I cases (5 of them died later), occurred mainly in hepatocellular carcinoma with superficial location, large tumors and severe cirrhosis, and implantation metastases in 5 cases, which were recognized as a subcutaneous nodule at the previous biopsy site. Implantation metastases were treated with resection or radiotherapy. Conclusion: FNA biopsy is valuable for the diagnosis of PLC. However, complications of post-biopsy hemorrhage should not be ignored, as such bleeding may be fatal. Implantation seems to have little effect on the prognosis. (c) 2007 Elsevier Ltd. All rights reserved.