Diagnostic accuracy of direct fine-needle aspiration of liver lesions: A prospective study of 107 patients in peripheral community center with limited technological capability

Imaging-guided fine-needle aspiration of liver lesions is a well established diagnostic method to distinguish malignant from benign lesions. However, its value remains to be determined in communities where the availability of high-tech imaging equipment is limited. The aim of this prospective study was to determine the value of nonimaging-guided (direct) fine-needle aspiration cytology in diagnosing liver lesions detected by technetium-99m, ultrasound and/or computed tomographic scanning of the liver as an alternative to imaging-directed fine needle aspiration. Based on histologic, cytologic and clinical findings, final liver diagnoses were made in 107 non-selected consecutive patients, of whom 52 had malignant and 55, benign liver disorders. Among the patients with malignant liver diseases, cytologic examination suspected malignancy in 1 patient, diagnosed definite malignancy in 41 cases, but failed to disclose malignancy in 10 patients. In patients with benign liver disease, the cytologic findings were reported as benign in all patients. Overall sensitivity, specificity, and positive and negative predictive values for cytologic results were 81, 100, 100 and 85%, respectively. The diagnostic accuracy of fine needle aspiration cytology was 85%. No major complications attributable to the procedure were recorded. We conclude that direct fine needle aspiration for cytodiagnosis is a simple and safe diagnostic method for evaluating the nature of liver lesions, particularly valuable where sophisticated technological equipment is unavailable.