Cell Block: A Tool to Improve Cytopathologic Diagnostic Value of Fine Needle Aspiration Material
Keywords:
FNAC, FNAB, Cell Block, Cytology, Cytopathology, Diagnostic Accuracy
Abstract
Background: The various advantages of Fine-needle aspiration (FNA) biopsy/ cytology can be limited due to inadequacy of the specimen and expertise required for diagnosis. Cell blocks (CBs), though routinely used in cytology of body fluids, can also be used in FNA material with considerable increase in diagnostic accuracy. Aims & objectives: To compared FNA & CB as diagnostic tool and to evaluate whether cell block adds to the diagnostic accuracy of FNA. Methods: This is a two years prospective study carried out in the pathology department of a tertiary heath care hospital and medical college of South India which included the cases undergoing the FNAC, and followed by the biopsy. CB was prepared using Tissue coagulum clot (TCC) method. The smears and tissue sections were assessed for cellularity and adequacy for diagnosis. CBs were grouped into four diagnostic categories. FNA & CB were compared with histopathology (HPE) diagnosis to calculate Sensitivity, Specificity and Diagnostic Accuracy. Result: A total of 195 cases were included. Cellularity and adequacy for diagnosis were higher in CB. They were diagnostically better (superior) in 13.84% (27) cases. The sensitivity (95.77%) and diagnostic accuracy (94.87%) of CB was found to be considerably higher than FNA (78.84% and 78.46% respectively). Conclusion: In cases of suspicious/ intermediate diagnosis or diagnosis discordant with clinical ones, by FNA; should be followed with the CB to improve the diagnostic yield & to facilitate accurate diagnoses. TCC method is a simple CB method which has higher diagnostic accuracy than FNA.References
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2. Basnet S, Talwar OP. Role of cell block preparation in neoplastic lesions. Journal of Pathology of Nepal. 2012;2:272-276.
3. Kulkarni MB, Prabhudesai NM, Desai SB, Borges AM. Scrape cell block technique for fine needle aspiration cytology smears. Cytopathology. 2000;11:179-84.
4. Buscarini L, Fornari F, Bolondi L, Colombo P, Livraghi T, Magnolfi F, Rapaccini GL, Salmi A. Ultrasound-guided fine-needle biopsy of focal liver lesions: techniques, diagnostic accuracy and complications: a retrospective study on 2091 biopsies. Journal of hepatology. 1990 Nov 1;11(3):344-8.
5. Bhatia P, Dey P, Uppal R, Shifa R, Srinivasan R, et al. Cell blocks from scraping of cytology smear: Comparison with conventional cell block. ActaCytol. 2008;52:329-333.
6. Bodele AK, Parate SN, Wadadekar AA, Bobhate SK, Munshi MM. Diagnostic utility of cell block preparation in reporting fluid cytology. J Cytol. 2003;20:133-135.
7. Qui L, Crapanzano JP, Saqi A, Vidhun R, Vazquez MF. Cell block alone as an ideal preparatory method for hemorrhagic thyroid nodule aspirates procured without onsite cytologists. Acta Cytol. 2008;52:139-144.
8. Khan AJ, Hingway SR, Raut WK. A new cost- effective cell block technique for optimisation of fine needle aspirates in bone Lesions. International journal of medical and applied sciences. 2013;2:324-333.
9. Zito FA, Gadaleta CD, Salvatore C, Filático R, Labriola A, et al. A modified cell block technique for fine needle aspiration cytology. Acta Cytol. 1995;39:93-99.
10. Krogerus LA, Anderson LC. A simple method for the preparation of paraffin-embedded cell blocks from fine needle aspirates, effusions and brushings. Acta Cytol. 1998;32:585-587.
11. Brown KT, Fulbright RK, Avitabile AM, Bashist B. Cytologic analysis in FNA biopsy: Smears versus cell blocks. AJR Am J Roentgenol 1993;161:629‑31.
12. Wojcik EM, Selvaggi SM. Comparison of smears and cell blocks in the fine needle aspiration diagnosis. Acta Cytol 1991;35:773‑6.
13. Karnanuchow PN, Bouin RE. Cell block technique for fine needle aspiration biopsy. J Clin Pathol. 1992;35:688.
14. Burt AD, Smillie D, Cowan MD, Adams FG. Fine needle aspiration cytology: Experience with a cell block technique. J Clin Pathol. 1986;39:114‑5.
15. Kung IT, Yuen RW. Fine needle aspiration of the thyroid. Distinction between colloid nodule and follicular neoplasm using cell blocks & 21 gauze needles. Acta Cytol. 1989;33:53‑60.
16. Kung IT, Chan SK, Lo ES. Application of the immunoperoxidase technique to cell blocks preparations from the fine needle aspirates. Acta Cytol. 1990;34:297‑303.
17. Jain D, Mathur SR, Iyer VK. Cell blocks in cytopathology: a review of preparative methods, utility in diagnosis and role in ancillary studies. Cytopathology. 2014;25(6):356-71. doi: 10.1111/cyt.12174. Epub 2014 Aug 11.
18. Wadhwa K, Bagga PK, Singh B, Paul S. Comparative Analysis of Cell Block Preparation Versus Smear Examination in the Fine Needle Aspirates of Head & Neck Lesions with Application of IHC Markers on Cell Block Preparation. International Journal of Contemporary Medical Research. 2019 June;6(6): F45-F49. DOI: http://dx.doi.org/10.21276/ijcmr.2019.6.6.42
19. Parate SN, Pawar PS, Kakade A. Role of Cell Block Preparation in Cytopathological Diagnosis. International Journal of Contemporary Medical Research 2019 July;6(7):G26- G31. DOI: http://dx.doi.org/10.21276/ijcmr.2019.6.7.47
20. Mathew EP, Nair V. Role of cell block in cytopathologic evaluation of image-guided fine needle aspiration cytology. J Cytol. 2017;34:133-8. Available from: http://www.jcytol.org/text.asp?2017/34/3/133/208112
21. Barsagade AK, Umap P, Deshpande A, Male P, Dhadas A, Jungare A et al. Diagnostic Utility of Cell Block Preparation of Fine Needle Aspiration Material. Sch. J. App. Med. Sci., Dec 2017; 5(12D): 5031-5037.
22. Patil RN, Mahore SD, Kolhe HS, Bothale KA, Gowardhan VP, Taori HS, et al. Cell Block Technique: An Effective Tool in Diagnostic Cytopathology. IOSR-JDMS. 2016 Dec;15(12):99-106.
23. Dahnert WF, Hoagland MH, Hamper UM, Erozan YS, Peirce JC. Fine needle aspiration biopsy of abdominal lesions: Diagnostic yield of different needle tip configurations. Radiology. 1992;185:263‑8.
24. Sanchez N, Selvaggi SM. Utility of cell blocks in the diagnosis of thyroid aspirates. Diagn Cytopathol 2006;34:89–92.
25. Saleh HA, Hammoud J, Zakaria R, Khan AZ. Comparison of Thin-Prep and cell block preparation for the evaluation of thyroid epithelial lesions on fine needle aspiration biopsy. CytoJournal 2008;5:3.
26. Loukeris K, Vazquez MF, Sica G et al. Cytological cell blocks: predictors of squamous cell carcinoma and adenocarcinoma subtypes. Diagn Cytopathol 2012; 40:380–7.
27. Righi L, Graziano P, Fornari A et al. Immunohistochemical subtyping of nonsmall cell lung cancer not otherwise specified in fine-needle aspiration cytology: a retrospective study of 103 cases with surgical correlation. Cancer 2011;117:3416–23.
28. Esterbrook G, Anathhanam S, Plant PK. Adequacy of endobronchial ultrasound transbronchial needle aspiration samples in the subtyping of non-small cell lung cancer. Lung Cancer 2013;80:30–4.
29. Collins BT. Endobronchial ultrasound fine-needle aspiration biopsy of pulmonary non-small cell carcinoma with subclassification by immunohistochemistry panel. Cancer Cytopathol 2013;121:146–54.
2. Basnet S, Talwar OP. Role of cell block preparation in neoplastic lesions. Journal of Pathology of Nepal. 2012;2:272-276.
3. Kulkarni MB, Prabhudesai NM, Desai SB, Borges AM. Scrape cell block technique for fine needle aspiration cytology smears. Cytopathology. 2000;11:179-84.
4. Buscarini L, Fornari F, Bolondi L, Colombo P, Livraghi T, Magnolfi F, Rapaccini GL, Salmi A. Ultrasound-guided fine-needle biopsy of focal liver lesions: techniques, diagnostic accuracy and complications: a retrospective study on 2091 biopsies. Journal of hepatology. 1990 Nov 1;11(3):344-8.
5. Bhatia P, Dey P, Uppal R, Shifa R, Srinivasan R, et al. Cell blocks from scraping of cytology smear: Comparison with conventional cell block. ActaCytol. 2008;52:329-333.
6. Bodele AK, Parate SN, Wadadekar AA, Bobhate SK, Munshi MM. Diagnostic utility of cell block preparation in reporting fluid cytology. J Cytol. 2003;20:133-135.
7. Qui L, Crapanzano JP, Saqi A, Vidhun R, Vazquez MF. Cell block alone as an ideal preparatory method for hemorrhagic thyroid nodule aspirates procured without onsite cytologists. Acta Cytol. 2008;52:139-144.
8. Khan AJ, Hingway SR, Raut WK. A new cost- effective cell block technique for optimisation of fine needle aspirates in bone Lesions. International journal of medical and applied sciences. 2013;2:324-333.
9. Zito FA, Gadaleta CD, Salvatore C, Filático R, Labriola A, et al. A modified cell block technique for fine needle aspiration cytology. Acta Cytol. 1995;39:93-99.
10. Krogerus LA, Anderson LC. A simple method for the preparation of paraffin-embedded cell blocks from fine needle aspirates, effusions and brushings. Acta Cytol. 1998;32:585-587.
11. Brown KT, Fulbright RK, Avitabile AM, Bashist B. Cytologic analysis in FNA biopsy: Smears versus cell blocks. AJR Am J Roentgenol 1993;161:629‑31.
12. Wojcik EM, Selvaggi SM. Comparison of smears and cell blocks in the fine needle aspiration diagnosis. Acta Cytol 1991;35:773‑6.
13. Karnanuchow PN, Bouin RE. Cell block technique for fine needle aspiration biopsy. J Clin Pathol. 1992;35:688.
14. Burt AD, Smillie D, Cowan MD, Adams FG. Fine needle aspiration cytology: Experience with a cell block technique. J Clin Pathol. 1986;39:114‑5.
15. Kung IT, Yuen RW. Fine needle aspiration of the thyroid. Distinction between colloid nodule and follicular neoplasm using cell blocks & 21 gauze needles. Acta Cytol. 1989;33:53‑60.
16. Kung IT, Chan SK, Lo ES. Application of the immunoperoxidase technique to cell blocks preparations from the fine needle aspirates. Acta Cytol. 1990;34:297‑303.
17. Jain D, Mathur SR, Iyer VK. Cell blocks in cytopathology: a review of preparative methods, utility in diagnosis and role in ancillary studies. Cytopathology. 2014;25(6):356-71. doi: 10.1111/cyt.12174. Epub 2014 Aug 11.
18. Wadhwa K, Bagga PK, Singh B, Paul S. Comparative Analysis of Cell Block Preparation Versus Smear Examination in the Fine Needle Aspirates of Head & Neck Lesions with Application of IHC Markers on Cell Block Preparation. International Journal of Contemporary Medical Research. 2019 June;6(6): F45-F49. DOI: http://dx.doi.org/10.21276/ijcmr.2019.6.6.42
19. Parate SN, Pawar PS, Kakade A. Role of Cell Block Preparation in Cytopathological Diagnosis. International Journal of Contemporary Medical Research 2019 July;6(7):G26- G31. DOI: http://dx.doi.org/10.21276/ijcmr.2019.6.7.47
20. Mathew EP, Nair V. Role of cell block in cytopathologic evaluation of image-guided fine needle aspiration cytology. J Cytol. 2017;34:133-8. Available from: http://www.jcytol.org/text.asp?2017/34/3/133/208112
21. Barsagade AK, Umap P, Deshpande A, Male P, Dhadas A, Jungare A et al. Diagnostic Utility of Cell Block Preparation of Fine Needle Aspiration Material. Sch. J. App. Med. Sci., Dec 2017; 5(12D): 5031-5037.
22. Patil RN, Mahore SD, Kolhe HS, Bothale KA, Gowardhan VP, Taori HS, et al. Cell Block Technique: An Effective Tool in Diagnostic Cytopathology. IOSR-JDMS. 2016 Dec;15(12):99-106.
23. Dahnert WF, Hoagland MH, Hamper UM, Erozan YS, Peirce JC. Fine needle aspiration biopsy of abdominal lesions: Diagnostic yield of different needle tip configurations. Radiology. 1992;185:263‑8.
24. Sanchez N, Selvaggi SM. Utility of cell blocks in the diagnosis of thyroid aspirates. Diagn Cytopathol 2006;34:89–92.
25. Saleh HA, Hammoud J, Zakaria R, Khan AZ. Comparison of Thin-Prep and cell block preparation for the evaluation of thyroid epithelial lesions on fine needle aspiration biopsy. CytoJournal 2008;5:3.
26. Loukeris K, Vazquez MF, Sica G et al. Cytological cell blocks: predictors of squamous cell carcinoma and adenocarcinoma subtypes. Diagn Cytopathol 2012; 40:380–7.
27. Righi L, Graziano P, Fornari A et al. Immunohistochemical subtyping of nonsmall cell lung cancer not otherwise specified in fine-needle aspiration cytology: a retrospective study of 103 cases with surgical correlation. Cancer 2011;117:3416–23.
28. Esterbrook G, Anathhanam S, Plant PK. Adequacy of endobronchial ultrasound transbronchial needle aspiration samples in the subtyping of non-small cell lung cancer. Lung Cancer 2013;80:30–4.
29. Collins BT. Endobronchial ultrasound fine-needle aspiration biopsy of pulmonary non-small cell carcinoma with subclassification by immunohistochemistry panel. Cancer Cytopathol 2013;121:146–54.
Published
30-07-2020
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