Immunocytochemistry: It′s role in diagnosis of undifferentiated neoplasms by fine needle aspiration cytology

Abstract

Background:Fine needle aspiration cytology (FNAC) is a rapid, cheap and reliable method for diagnosing any accessible lesion. However, there remains a group of malignant undifferentiated neoplasms, which can only be categorized with the help of immunocytochemistry (ICC). The categorization is important due to their vast difference in treatment and prognosis.Aim:To evaluate the effectiveness of ICC in categorizing the undifferentiated neoplasms diagnosed on routine FNAC smears.Materials and Methods:Thirty six cases of undifferentiated neoplasms were selected from a group of total 78 cytology cases of undifferentiated tumors from different sites like head and neck, lymph node, soft tissue etc. These were then subjected to a panel of ICC markers based on the clinical and cytomorphological features.Results:Of these, 21 were simple, ten were computerized tomography guided and five were ultrasound guided FNACs respectively. All the 78 cases were confirmed by histopathological examination and immunohistochemistry. Of the 36 cytological cases, final diagnosis correlated in 30 cases histologically. The six cases were incorrect either due to inadequate material on the smears (three cases) or false positive staining (three cases).Conclusions:Our study found that ICC is a sensitive and specific method for early and definitive diagnosis of undifferentiated neoplasms. However, selection of antibodies must be judicious to make it cost effective.

The role of immunohistochemistry for diagnosing undifferentiated malignancy in the head and neck region

“…In our study it was observed that male to female ratio was 4.8:1. Similar observations regarding the head and neck region malignancy is predominant in male subjects also observed by Mandalet al 12 In our study it was observed that over one-third patients had cervical lymphadenopathy, one-third had neck mass and one-tenth had mass in nasal/sinonasal region. Almost similar findings was reported Bianchini et al 13 who obtained the lymph nodes (20.9%), pharynx and neck mass (16.3%), paranasal sinus (14.0%) and nose (11.6%) constituted the majority of sites.…”

Antigens under cover—The preservation and demasking of selected antigens for successful poststaining immunocytochemistry of effusion, brain smears, and lymph node aspirates

“…According to the ROSE concept (Rapid On‐Site Evaluation), cytologic examination is a valuable tool for establishing a definitive tissue diagnosis in practice and can complement histologic studies by revealing previously unrecognized features . There is, however, an enormous demand for more specific diagnoses to confirm or specify atypical and rare infections or undifferentiated neoplasia . Special stains are recommended to be performed in parallel with routine Romanowsky‐stained smear evaluations using separate unstained smears .…”

“…Other infectious diseases and tumor cell antigens, however, could require preselection and cytomorphologic characterization of the cells to be stained . This holds true, in particular, for advanced tumor diagnoses . Immunocytochemistry (ICC) on Romansky‐stained (prestained) slides (poststaining ICC, PSICC) could help identify the histogenetic origin of tumors or cell types, characterize cells that cannot be identified with conventional stains, and obtain further prognostic and predictive information .…”

Comparative study of cytology and immunocytochemistry with trucut biopsy and immunohistochemistry in diagnosis of localized lung lesions: A prospective study

“…Several other authors used a combination of markers in cytology specimens and showed efficacy comparable to trucut. [ 21 22 23 24 ] Newer markers like napsin-A are more specific for lung adenocarcinomas and likely to prove more effective in the near future. [ 25 ]…”