A review of 50 consecutive cytology cell block preparations in a large general hospital.

Abstract

Aims-To review consecutive cell block preparations of cytological specimens in a large general hospital. Methods-50 cell blocks were made over an 18 month period in which about 1900 fine needle aspirations (FNAs) were performed. The aspirator was a cytologist or, for image guided FNAs, a radiologist with a cytologist at hand to collect the specimen. Forty eight cell blocks were from FNAs and two were from serous fluids. Results-The cellularity of the cell blocks was inadequate in only four preparations. The main motive for making cell blocks was to obtain tissue for immunohistochemistry. This was performed on 28 cases and a total of 107 immunostained sections were produced. The most common diagnostic dilemma was between carcinoma and melanoma, and the second most common between carcinoma and lymphoma. Consequently cytokeratin, S-100, and LCA were the most frequently used antibodies. At least one ofthese three antibodies was positive in 17 cases. Five cases were immunostained only for prognostic breast markers. Conclusions-The use of cell block immunohistochemistry is a reliable and technically unsophisticated aid in the cytological examination of tumours other than lymphomas. Success depends on having highly experienced aspirators that reliably obtain sufficiently cellular material. (C Clin Pathol 1997;50:985-990) Keywords: cell block; immunohistochemistry; fine needle aspiration cytology; audit Cytology cell blocks are made by centrifuging cytology specimens to form solid pellets. Paraffin wax embedded sections can be cut for haematoxylin and eosin histology and special stains, including immunohistochemistry. This study reviewed 50 consecutive cell block preparations of cytological specimens in a large general hospital. Patients and methodsThe vast majority of cell block specimens were obtained from fine needle aspirations (FNAs). These were performed as part of a near-patient rapid diagnosis FNA service. A second FNA was used to collect the specimen for the cell block after the initial diagnosis had been made on the first specimen. The image guided FNAs (17 cases) were performed by a consultant radiologist with a cytologist at hand to collect the specimen. A variety of needles was used depending on the site. The manually guided FNAs (31 cases) were performed with a 23 gauge 3.75 cm needle using a "needle only" technique and the operator was always a consultant pathologist with a special interest in FNA cytopathology. Maximum material was collected by extensive agitation of the needle in the lesion. Ten per cent formal saline was drawn up though the needle into an attached syringe and then gently ejected back into a specimen container.

Comparison of the diagnostic accuracy of cell block with cytology smear in serous effusions

“…Cotton block method is another alternative by which cytomorphological features in body fluids can be studied. 11,[15][16][17] In this study, all three malignancies found in the smears and blocks were adenocarcinomas. This comprised 8.1 % of cases (3/37).…”

“…So, different antibodies serve as reliable markers in the differential diagnosis of reactive mesothelial cells, adenocarcinona and malignant mesothelioma in serous effusions. [7][8][9][10][11][12][13][14] This diagnostic dilemma can be furthered settled by staining with PAS stain, D-PAS, Alcian blue and Hyranuronidase alcian blue. Introduction of CK 5/6 and calretinin helps in differentiating mesothelioma from adenocarcinoma.…”

Comparative study of cell block versus centrifuged smear examination from aspirates of cystic lesions

“…Delay in the diagnosis when compared to conventional smears due to additional time for CB preparation, [17] risk of losing material during processing and increased cost are some of the drawbacks. [26] Some authors like Wojick et al found that the additional studies of cell blocks is of little benefit after a study CB in a case of hepatic hydatid cyst showing protoscolices, recurrent SCC of oral cavity. [23] They suggested that CB is a forgotten tool these days and reemphasized it's utility in CB was non-contributory.…”

“…They concluded that the use which aid in the cytological examination. [26] Though CB complements CS diagnosis with added advantage of better architecture, availability of material for special stains and IHC in many cases, CB also has certain disadvantages. Delay in the diagnosis when compared to conventional smears due to additional time for CB preparation, [17] risk of losing material during processing and increased cost are some of the drawbacks.…”

Positron Emission Tomography/Computed Tomography after Immunocytochemical and Clonal Diagnosis of Intraocular Lymphoma with Vitrectomy Cell Blocks

“…11,12 A larger number of cells in a compacted area of one section on a slide glass, compared with sparse cells on the smear, leads to a more accurate diagnosis. Furthermore, paraffin sections can be used later for immunocytochemical diagnosis and clonal analysis.…”