Value and limitations of cytologic criteria for the diagnosis of hepatocellular carcinoma by fine needle aspiration biopsy.

In order to further evaluate the utility of fine needle aspiration biopsy (FNAB) cytology for the diagnosis of hepatocellular carcinoma (HCC), we analyzed 39 cytologic features in a series of 102 FNABs from HCC and compared them with 28 FNABs from nonneoplastic conditions. Thirteen features were significantly associated with HCC; from them a stepwise logistic regression analysis selected the three most predictive: irregular arrangement, irregular chromatin pattern and uniformly smaller cytoplasm, the last two found only in HCC. Using different specific combinations of significant cytologic features, the highest sensitivity obtained was 84.3%, with 100% specificity. Sixteen HCC cases could not be diagnosed specifically using the criteria defined in this study, probably due to their well-differentiated nature or to sampling error. Although the use of additional techniques, such as cell block preparations, would improve the results in well-differentiated tumors, we recommend basing the early diagnosis of small HCC on a multidisciplinary approach.