K. S. Likhar¹, S. SakhUja³, N. Sawke¹, S. K. Likhar², Puja¹ and M. K. Mishra²

¹Department of Pathology, Peoplces College of Medical Sciences and Research Centre, Bhanpur, Bhopal - 462 010 India.

²Department of Community Medicine, Peoplces College of Medical Sciences and Research Centre, Bhanpur, Bhopal - 462 010 India.

³Department of Pathology, G.S.V.M. Medical College, Kanpur India.

Abstract

FNAC is used in the present study as a clinching investigation of palpable & non-palpable, intra-abdominal mass which may prove to be neoplastic or non-neoplastic. FNAC was done on patients attending OPD as well as admitted in the Medicine, Surgery, Obs/Gynae department, LLR & associated hospitals, Kanpur presenting with intra-abdominal lumps Patients clinically diagnosed as cases of intra-abdominal lumps were studied thoroughly & subjected to detailed clinical history with regards to age, sex, occupation chief complaints. patients are subjected to routine investigations like Hb%,TLC,DLC,ESR,GBP,BT,CT,PT,whenever needed followed by FNA either directly or USG guided. The smear was stained with H & E and Pap smear was categorized into inflammatory, benign, malignant lesions on the basis of individual cell and nuclear morphology. The entire study was statistically analyzed for its sensitivity, specificity and overall accuracy. Total 46 cases were included in our study of which most cases was USG guided. Most commonly involved organ in our study was liver 30.4% followed by intestine 21.7% and gall bladder 17.4%. Maximum no. of cases in our study were of malignant lesion 63.06%wheras benign & inflammatory lesions constituted 6.51% and 23.92% of the cases respectively 6.5 % aspirates were inconclusive / inadequate for diagnosis. 100 % accuracy was obtained in cases of liver, intestine, ovary and kidney cases.The overall sensitivity of FNAC on our study was 91.3%. FNAC provides a very convenient, simple, inexpensive and accurate method for preoperative diagnosis; at the same time it enables the surgeon to plan the modality of treatment accordingly.

Keywords

FNAC; Intra-abdominal lump

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Copy the following to cite this article: Likhar K. S, SakhUja S, SawkeN, Likhar S. K, Puja, Mishra M. K. Role of FNAC in Diagnosis of Intra-Abdominal Lump and its Histological Correlation. Biomed Pharmacol J 2009;2(2)

Copy the following to cite this URL: Likhar K. S, SakhUja S, SawkeN, Likhar S. K, Puja, Mishra M. K. Role of FNAC in Diagnosis of Intra-Abdominal Lump and its Histological Correlation. Biomed Pharmacol J 2009;2(2). Available from: http://biomedpharmajournal.org/?p=949

Introduction

FNAC is the valuable diagnostic technique & gaining popularity because it is safe, simple and less expensive and carried on the patient with minimum discomfort. Initially it was limited to the superficial organs but modern imaging techniques like USG & CT have made it possible for the deeper organs also. So FNAC is being used in the present study as a clinching investigation of palpable & non-palpable, intra-abdominal mass which may prove to be neoplastic or non-neoplastic.

Material and Methods

FNAC was done on patients attending OPD as well as admitted in the Medicine, Surgery, Obs/Gynae department, LLR & associated hospitals, Kanpur presenting with intra-abdominal lumps.

Selection of patients

Patients clinically diagnosed as cases of intra-abdominal lumps were studied thoroughly & subjected to detailed clinical history with regards to age, sex, occupation& chief complaints. History of present illness was taken with mode of onset, site, size, shape, origin and progress of swelling, duration of illness, presence of any associated illness. History of past illness was also taken with regards to similar illness in the past. All these patients are subjected to routine investigations like Hb%,TLC,DLC,ESR,GBP,BT,CT,PT,whenever needed in patients of jaundice followed by FNA either directly or USG guided.

Processing of material

Smear prepared from aspirated material was fixed in absolute alcohol. In case of cystic lesions like ovarian cyst 5-10 cc of fluid was aspirated & smear was made from deposits after centrifugation. Usually H/E stain was used & other stains like MGG and PAP were also used when required.

Interpretation of FNAC

Each smear was examined after staining under 10X to get idea of overall cellularity, then under  40X get morphological details of individual cells. The smear viewed was categorized into inflammatory, benign, malignant lesions on the basis of individual cell and nuclear morphology.

Statistical analysis

The entire study was statistically analyzed for its sensitivity, specificity and overall accuracy.

Observations

Total 46 cases were included in our study of which most cases was USG guided. Most commonly involved organ in our study was liver 30.4% followed by intestine 21.7% and gall bladder 17.4%.Maximum number of cases in our study was in sixth decade followed by fifth & fourth decade. Majority of cases in our study were malignant lesion, the reason behind this fact is inclusion of patients of higher age group.

Maximum number of cases in our study were of malignant lesion 63.06%wheras benign & inflammatory lesions constituted 6.51% and 23.92% of the cases respectively. 6.5 % aspirates were inconclusive / inadequate for diagnosis. Out of 46 cases only 23 cases were subjected for histopathological correlation amongst all such cases there were more number of malignant lesions.100 % accuracy was obtained in cases of liver, intestine, ovary and kidney masses.

 Table 1: Distribution of lesion according to anatomical site

Site	No. of cases	Percentage
Liver	14	30.4
Gall bladder	08	17.4
GIT	10	21.7
Lymph node	05	10.8
Retroperitoneum	01	2.1
Kidneys & adrenals	02	4.3
Ovaries	06	13.2
Total	46	100

 

Table 2: Age distribution of cases.

Age groups	No. of cases	Percentage
0-10	02	4.34
11-20	04	8.69
21-30	06	13.04
31-40	08	17.39
41-50	09	19.56
51-60	12	26.09
>60	05	10.91
Total	46	100

 

Table 3: Distribution of cases according to FNAC findings. 

Organ involved	Inflammation Total       %		Benign Total     %		Malignant Total     %		Inadequate Total    %		Total
Liver	2	4.34	1	2.17	10	21.73	1	2.17	14
Gall bladder	1	2.17	–	–	6	13.04	1	2.17	8
GIT	6	13.04	–	–	3	6.52	1	2.17	10
Lymph node	2	4.34	–	–	3	6.52	–	–	5
Retroperitoneum	–	–	–	–	1	2.17	–	–	1
Kidneys & adrenals	–	–	–	–	2	4.34	–	–	2
Ovaries	–	–	2	4.35	4	8.69	–	–	6
Total	11	23.92	3	6.51	29	63.06	3	6.51	46

 

Table 4: Correlation between Histological diagnosis & FNAC

Histological diagnosis	No. of cases	FNAC Findings Correct         Incorrect		Accuracy    (%)
Gall bladder Chronic cholecystitis Adnocarcinoma	02 04	02 03	– 01	83.3
Liver Hepatocellular CA Metastatic Adeno CA	02 02	02 02	– –	100
Martin and Ellis (1968) Intestine Tuberculosis Adenocarcinoma colon	01 02	01 02	– –	100
Lymph Nodes Tuberculosis NHL Metastatic CA	01 01 02	01 01 01	– – 01	75
Kidney Wilm’s tumor Renal call carcinoma	01 01	01 01	– –	100
Ovary Simple serous cyst Papillary cystadeno CA Mutinous cystadeno CA	01 02 01	01 02 01	– – –	100

Discussion

In our study 46 cases of intra-abdominal lump were subjected to USG guided FNAC. USG revealed that mass lesions were localized in the liver  30.4% followed by intestine 21.7% and gall bladder 17.4%,lymph node 10.9 %,Kidneys /adrenal4.3%,retroperitoneal 2.1% and ovary 13.2%.

The youngest patient in the study was 2 yrs old child & oldest was 65 yr old female. Benign lesion were seen more commonly in <40 yrs of age, while malignant lesions were more common in patients >40 yrs age. Only one case of malignancy was in child <7 yrs age, cytodiagnosis was Wilm’s tumour.

Incidence of intra-abdominal lump was slightly higher in females than males with male to female ratio of 1:1.18.Incidence of malignancy in our study was 67 %, benign lesion 8.7%, inflammatory lesion constituted 17 % of cases.Material was inadequate in 6.5% of cases giving overall accuracy of 93.5%. Martin and Ellis (1968) when introduced this method were able to obtain representative tissue in 80% of cases. Obers et al (1991) in their study of intra-abdominal lumps by FNA obtained tissue successfully in 88.7 % of cases.

Enrique et al (1996) reported overall accuracy of 90.7% our findings are congruent with studies conducted by above workers.

Results obtained in organwise study of FNAC in intra-abdominal lumps are as follows: In our study Liver was most commonly involved organ.Out of 14 cases, diagnostic aspirate were obtained in 13 cases with adequacy of 97.8%.

Most of the lesions in liver were malignant 10 cases (out of which 3 were HCC,6 metastatic adenocarcinoma & 1 case as lymphoma) 3 benign cases ( 2 were liver abscess,1 as liver cell adenoma).The accurate diagnosis was obtained in 92.8 % cases which corresponds well with Cochand et al (1987) who reported accuracy of 86% in hepatic lesions by FNAC.

Herszenye et al (1995) in his study on hepatic masses found malignant lesions in 73 % cases & benign lesion in 27 % cases. In our study total malignant cases were 85.7% while benign lesion were 21.4 %.One reason for large no. of malignant cases could be the more no. of elderly patients in study group.

In our study 3 cases were diagnosed as HCC, subsequent histological diagnosis confirmed 2 cases. We achieved 100 % accuracy of FNAC in diagnosis of HCC.Bolling et al (1990) achieved diagnostic accuracy of 82.9% in diagnosis of HCC.

8 cases of Gall bladder were subjected to FNAC with adequacy of diagnostic aspirates obtained was 87.5 %. Cytodiagnosis of chronic cholecystitis (1), adenoCA (6) & inadequate (1).Two cases of adenoCA were confirmed on subsequent histological examination. Overall accuracy of GB mass in our study was 83.35% .Pachori  et al (1989) obtained correct diagnosis in 5 out of 6 GB aspirates with accuracy of 83.4%.

The overall sensitivity of FNAC in our study was 91.3% & we found accuracy of FNAC in diagnosing various intra abdominal lumps varied from 75-100%.Considering the only alternative way of diagnosis by laparotomy it provides a very convenient, simple, inexpensive and accurate method for preoperative diagnosis, at the same time it enables the surgeon to plan the modality of treatment accordingly.

Conclusion

FNAC being a safe OPD procedure can be used as an important diagnostic tool for any abdominal mass. Out of  46 cases of intra-abdominal lump, frequency of organ involvement was maximum with liver  30.4% followed by intestine 21.7% and gall bladder 17.4%,lymph node 10.9 %,Kidneys /adrenal 4.3%,retroperitoneal 2.1% and ovary 13.2%.

Incidence of malignancy in our study was 67 %, benign lesion 8.7%, inflammatory lesion constituted 17 % of cases, material was inadequate in 6.5% of cases. Which  gives a  overall accuracy of 93.5%.

Out of 46 cases only 23 cases were subjected for histopathological correlation amongst all such cases there were more no. of malignant lesions.100 % accuracy was obtained in cases of liver, intestine, ovary and kidney cases. The overall sensitivity of FNAC on our study was 91.3%.

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