Reliability of combined fine needle aspiration and core needle biopsies in the diagnosis of liver lesions: An 8-year institutional experience.

OBJECTIVE: Fine needle aspiration (FNA), followed by core needle biopsy (CNB) when needed, was adopted as the standard care for liver lesions in our institution. This study explores the diagnostic efficacy of combined image-guided FNA and CNB in liver lesion diagnosis. METHOD: We retrospectively reviewed all liver FNA cases performed in our institution between January 2010 and September 2018. A total of 550 cases from 531 patients (173 females) with a median age of 59 years (range, 13-90) were identified. All FNA cases were initially assessed with rapid on-site evaluation, and cell blocks were prepared. A total of 459 FNA specimens with concurrent CNBs were included in the study. Both FNAs and CNBs in the paired sampling were read by a cytopathologist, with expert consultation as needed. RESULTS: The concordance rate between FNA and CNB was 85.2%. Combined FNA/CNB showed higher sensitivity in detecting malignant tumours when compared to FNA or CNB alone (98%, vs 87% and 92%, p < 0.001), especially for detecting metastatic tumours, hepatocellular carcinoma, and haematopoietic neoplasms (98%, 97%, and 94%, respectively; all p < 0.001). Combined FNA/CNB showed a lower false negative rate in malignant tumours than FNA or CNB alone (2%, vs 13% and 8%, p < 0.001). There was no significant difference among FNA, CNB, and combined FNA/CNB in diagnosing benign liver lesions. CONCLUSIONS: Combined liver FNA/CNB has high diagnostic efficacy for malignancy and a lower false negative rate than either procedure alone, especially in metastatic tumours, hepatocellular carcinoma, and haematopoietic neoplasms.

Portal vein thrombosis leading to pre-sinusoidal non-cirrhotic portal hypertension resulting in decreased synthetic function of the liver.

Non-cirrhotic portal hypertension (NCPH), defined as elevated portal pressures in the absence of cirrhosis, is a relatively rare cause of elevated portal pressures in western countries. In NCPH decompensated liver disease is common, but complications are often mitigated by appropriate medical therapy. Liver synthetic function loss is uncommon. We present a unique case of a patient with biopsy proven NCPH, who eventually developed progressive loss of hepatic synthetic function in the setting of long standing portal hypertension. This loss of synthetic function corresponded with the interval development of incomplete septal cirrhosis (ISC), and progression of previously noted nodular regenerative hyperplasia in biopsies performed 7 years apart. Our patient's clinical course was complicated by multiple hospitalizations for gastrointestinal hemorrhage. Patients with ISC have higher rates of bleeding varices when compared to patients with macronodular cirrhosis. While patients with NCPH typically have better overall survival and fewer bleeding complications than cirrhotic patients, this is typically attributed to the former having preserved synthetic function. It appears that the presence of ISC may be a poor prognosticator in patients with NCPH.