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Article: Impact of Preoperative Fine-needle Aspiration Cytologic Examination on Clinical Outcome in Patients with Hepatocellular Carcinoma in a Tertiary Referral Center

TitleImpact of Preoperative Fine-needle Aspiration Cytologic Examination on Clinical Outcome in Patients with Hepatocellular Carcinoma in a Tertiary Referral Center
Authors
Issue Date2004
PublisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.com
Citation
Archives Of Surgery, 2004, v. 139 n. 2, p. 193-200 How to Cite?
AbstractHypothesis: 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 α-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 α-fetoprotein concentration is not diagnostic.
Persistent Identifierhttp://hdl.handle.net/10722/88820
ISSN
2014 Impact Factor: 4.926
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorNg, KKCen_HK
dc.contributor.authorPoon, RTPen_HK
dc.contributor.authorLo, CMen_HK
dc.contributor.authorLiu, CLen_HK
dc.contributor.authorLam, CMen_HK
dc.contributor.authorNg, IOLen_HK
dc.contributor.authorFan, STen_HK
dc.date.accessioned2010-09-06T09:48:25Z-
dc.date.available2010-09-06T09:48:25Z-
dc.date.issued2004en_HK
dc.identifier.citationArchives Of Surgery, 2004, v. 139 n. 2, p. 193-200en_HK
dc.identifier.issn0004-0010en_HK
dc.identifier.urihttp://hdl.handle.net/10722/88820-
dc.description.abstractHypothesis: 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 α-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 α-fetoprotein concentration is not diagnostic.en_HK
dc.languageengen_HK
dc.publisherAmerican Medical Association. The Journal's web site is located at http://www.archsurg.comen_HK
dc.relation.ispartofArchives of Surgeryen_HK
dc.subject.meshAdulten_HK
dc.subject.meshAgeden_HK
dc.subject.meshAnalysis of Varianceen_HK
dc.subject.meshBiopsy, Needle - adverse effects - methodsen_HK
dc.subject.meshCarcinoma, Hepatocellular - mortality - pathology - surgeryen_HK
dc.subject.meshCase-Control Studiesen_HK
dc.subject.meshConfidence Intervalsen_HK
dc.subject.meshDisease-Free Survivalen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHepatectomy - methods - mortalityen_HK
dc.subject.meshHumansen_HK
dc.subject.meshImmunohistochemistryen_HK
dc.subject.meshLiver Neoplasms - mortality - pathology - surgeryen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshMultivariate Analysisen_HK
dc.subject.meshNeoplasm Seedingen_HK
dc.subject.meshNeoplastic Cells, Circulating - pathologyen_HK
dc.subject.meshPreoperative Care - methodsen_HK
dc.subject.meshProbabilityen_HK
dc.subject.meshPrognosisen_HK
dc.subject.meshProportional Hazards Modelsen_HK
dc.subject.meshReference Valuesen_HK
dc.subject.meshReferral and Consultationen_HK
dc.subject.meshRetrospective Studiesen_HK
dc.subject.meshRisk Assessmenten_HK
dc.subject.meshSurvival Analysisen_HK
dc.subject.meshTreatment Outcomeen_HK
dc.titleImpact of Preoperative Fine-needle Aspiration Cytologic Examination on Clinical Outcome in Patients with Hepatocellular Carcinoma in a Tertiary Referral Centeren_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0004-0010&volume=139&issue=2&spage=193&epage=200&date=2004&atitle=Impact+of+preoperative+fine-needle+aspiration+cytologic+examination+on+clinical+outcome+in+patients+with+hepatocellular+carcinoma+in+a+tertiary+referral+centeren_HK
dc.identifier.emailPoon, RTP: poontp@hkucc.hku.hken_HK
dc.identifier.emailLo, CM: chungmlo@hkucc.hku.hken_HK
dc.identifier.emailNg, IOL: iolng@hkucc.hku.hken_HK
dc.identifier.emailFan, ST: stfan@hku.hken_HK
dc.identifier.authorityPoon, RTP=rp00446en_HK
dc.identifier.authorityLo, CM=rp00412en_HK
dc.identifier.authorityNg, IOL=rp00335en_HK
dc.identifier.authorityFan, ST=rp00355en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1001/archsurg.139.2.193en_HK
dc.identifier.pmid14769580-
dc.identifier.scopuseid_2-s2.0-0842331403en_HK
dc.identifier.hkuros90556en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0842331403&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume139en_HK
dc.identifier.issue2en_HK
dc.identifier.spage193en_HK
dc.identifier.epage200en_HK
dc.identifier.isiWOS:000188791000016-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridNg, KKC=7403179075en_HK
dc.identifier.scopusauthoridPoon, RTP=7103097223en_HK
dc.identifier.scopusauthoridLo, CM=7401771672en_HK
dc.identifier.scopusauthoridLiu, CL=7409789712en_HK
dc.identifier.scopusauthoridLam, CM=7402989820en_HK
dc.identifier.scopusauthoridNg, IOL=7102753722en_HK
dc.identifier.scopusauthoridFan, ST=7402678224en_HK

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