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Kelvin Kwok-Chai Ng, MBBS(HK), FRCSEd(Gen); Ronnie Tung-Ping Poon, MS, FRCS(Edin); Chung-Mau Lo, MS, FRCS(Edin), FRACS; Chi-Leung Liu, MS, FRCS(Edin); Chi-Ming Lam, MS, FRCS(Edin); Irene Oi-Lin Ng, MD, FRCPath; Sheung-Tat Fan, MS, MD, PhD, FRCS(Glasg & Edin)

Arch Surg. 2004;139:193-200.

Hypothesis  Preoperative fine-needle aspiration cytologic examination (FNAC) exerts a statistically significant adverse effect on long-term clinical outcome in patients with hepatocellular carcinoma (HCC).

Design  Retrospective study.

Setting  Tertiary referral center.

Patients  A total of 828 patients with clinical suggestion of HCC received surgical treatment. Ninety-one patients underwent preoperative FNAC, suggesting HCC, and 737 patients did not.

Main Outcome Measures  The resectability and histologic diagnoses of liver masses were evaluated in patients with and without preoperative FNAC. Clinicopathologic data and operative and survival outcomes of patients who underwent curative hepatic resection for HCC were compared between the FNAC and non-FNAC groups.

Results  The resectability rates of the FNAC (81.3%) and non-FNAC (81.8%) groups did not differ (P = .91). Histologic examination of tumor confirmed HCC in 766 patients. The positive predictive value of preoperative FNAC was 96%, whereas that of preoperative imaging studies was 92% (P = .23). Among patients with nondiagnostic serum -fetoprotein concentrations (400 ng/mL), 3% in the FNAC group (n = 66) had benign liver diseases vs 9.5% in the non-FNAC group (n = 432) (P = .09). Among patients with curative hepatic resection (70 in the FNAC group and 545 in the non-FNAC group), hospital mortality was 4% and 6% in the FNAC and non-FNAC groups, respectively. In the FNAC group, needle tract tumor seeding was not encountered. Excluding patients with preexisting and iatrogenic tumor rupture, intraperitoneal extrahepatic metastasis occurred in 1 patient (2%) in the FNAC group and in 30 (6%) in the non-FNAC group (P = .34). The cumulative 1-, 3-, and 5-year overall survival rates were 79%, 61%, and 48%, respectively, for the FNAC group and 75%, 55%, and 43% for the non-FNAC group (P = .77). The disease-free survival results of the groups were similar (P = .51).

Conclusions  Preoperative FNAC has no statistically significant adverse effect on the operability, the possibility of extrahepatic tumor spread, or the long-term survival of patients with HCC. Preoperative FNAC may play a diagnostic role in selected patients with liver nodules on imaging studies when the serum -fetoprotein concentration is not diagnostic.

From the Departments of Surgery (Drs K. Ng, Poon, Lo, Liu, Lam, and Fan) and Pathology (Dr I. Ng), Centre for the Study of Liver Disease, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong.

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