engleski

Utility of Fine Needle Aspiration Biopsy of Hepatocellular Carcinoma in Patients with Liver Transplantation

Hepatocelullar carcinoma (HCC) is among the most common malignancies worldwide and the third leading cause of cancer deaths. The increasing incidence of HCC and hepatitis C virus (HCV) in the western world has been observed in recent years. Although advances in imaging techniques obviate the morphological confirmation of clinicaly classic HCC, detection of smaller lesions, especially in patients with cirrhosis and chronic hepatitis, is needed. The preoperative accurate diagnosis of HCC with assessment of an accurate tumor size, number of nodules and the major hepatic vessels invasion are the main considerations in selecting patients for liver transplantation, defined with the Milan criteria. The aim of this study was to evaluate the role of fine needle aspiration biopsy (FNAB) in diagnosis and management of HCC in patients with liver transplantation. During 2002–2012, 71 patients with HCC had undergone liver transplantation. 26 (36.61%) patients had guided FNAB during the preoperative evaluation and in 6 (23.08%) patients FNAB was performed in the follow up period. The FNAB results were compared with histopathology findings after liver transplantation. All patients had HCC with present cirrhosis. According etiology in 30 (42.25%) patients the cause of cirrhosis was alcohol, in 22 (30.98%) patients HCV, in 8 (11.26%) patients hepatitis B virus, in 2 (2.81%) patients primary biliary cirrhosis and in 5 (7.04%)patients the cause of cirrhosis was unknown, cryptogenic. The 30 (42.25%) patients fulfilled the Milan criteria during liver transplantation. Majority of HCC (53.52%) were £3 cm with present 2–3 tumor nodules (45.07%). According WHO Classification of HCC characteristics all HCC were classical type, moderately differentiated (73.23%) and architecturally characterized by trabecular (59.15%)or mixed trabecular–acinar (30.98%) growth pattern. In 14 (19.72%) patients macro or microvascular invasion was present. In 23 of 26 patients with FNAB the accurate diagnosis was made, with sensitivity of 88.46% and specificity of 100%. Majority of HCC (65.38%) diagnosed by FNAB were £3 cm and 12 of 26 patients (46.15%) had normal a-fetoprotein concentrations. The tumor recurrence after liver transplantation was diagnosed by guided FNAB in two patients in liver and in four patients in metastatic intraabdominal lymph nodes. In the follow up period no tumor seeding following FNAB was observed. To conclusion, among patients with HCC guided FNAB is a useful diagnostic method especially in small tumors with normal afetoprotein concentrations, and also a useful method in diagnosis of the tumor recurrence in the follow up period.

Fine Needle Aspiration Biopsy; Hepatocellular Carcinoma

nije evidentirano