Ultrasound-Guided Fine Needle Aspiration in Differential Diagnosis of Portal Vein Thrombosis in Patients with Hepatocellular Carcinoma

Background and Study Aims: Portal vein thrombosis (PVT) associated with untreated HCC are almost always malignant, still benign portal vein thrombus should be considered as well, This study was designed to study the value of ultrasound-guided fine needle aspiration cytology in the differential diagnosis of portal vein thrombosis. Patients and Methods: This study included 20 patients with chronic liver disease and hepatocellular carcinoma (associated with portal vein thrombosis). All the patients were subjected to abdominal ultrasonography, color coded duplex sonography of portal vein and ultrasound guided fine needle aspiration cytology of portal vein thrombus. Results: FNAC was positive for malignant cells in 70% of cases, the presence of either complete thrombus and/or positive intralesional signals were exclusive for malignant nature (p-value was 0.042 & 0.002 respectively). CCDS had a sensitivity of 78.6%, specificity of 100%, positive predictive value of 100%, negative predictive value of 66.7% for the diagnosis of malignant PVT with a total accuracy of 85%. Conclusion: Ultrasound-guided fine-needle aspiration of portal vein thrombosis is a feasible, accurate and well-tolerated procedure in the diagnosis of the nature of portal vein thrombus associated with hepatocellular carcinoma.