Modified Plasma-Thrombin Method of Cell Block Preparation for Fine-Needle Aspiration Biopsies in Resource-Limited Settings

Aisagbonhi, Omonigho; Birungi, Abraham; Atwine, Raymond; Behayo, Paddy; Ayebaziwe, Benon; Roberts, Drucilla J.; Tambouret, Rosemary

doi:10.1093/ajcp/aqy031

Cited by 10 publications

(4 citation statements)

References 36 publications

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“…29,[33][34][35] However, the lack of systematic evaluation and standardization of the dozens of available cell block preparation methods limits the expansion of the use of the same in low-resource settings. [36][37][38][39] Strengthening the capacity of diagnostic cytopathology services by coupling them with ancillary tests such as cell blocks and IHC would also improve cancer care in Tanzania by shortening time and reducing the cost needed to achieve a definitive diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Evaluating Estrogen Receptor Immunohistochemistry on Cell Blocks From Breast Cancer Patients in a Low-Resource Setting

Kimambo

Vuhahula

Mwakigonja

et al. 2020

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Breast cancer biomarker assessment is critical in determining treatment and prognosis. In Tanzania, immunohistochemistry (IHC) is limited to surgical specimens and core biopsies. However, performing IHC on fine-needle aspiration biopsy cell blocks would offer numerous advantages. Objective.— To compare the performance between estrogen receptor (ER) IHC performed at Muhimbili National Hospital (MNH) in Tanzania and ER IHC performed at University of California, San Francisco (UCSF), to demonstrate feasibility of performing IHC using cell blocks in Tanzania. Design.— Patients with breast masses were recruited prospectively from the fine-needle aspiration biopsy clinic at MNH. Estrogen receptor IHC results on cell blocks, performed at both MNH and UCSF, and corresponding tissue blocks, performed at MNH, were compared to determine concordance. Results.— Eighty-six cell blocks were evaluated by ER IHC at MNH, with 41 of 86 (47.7%) positive and 45 of 86 (52.3%) negative. Among 65 UCSF and MNH cell block pairs, overall ER IHC concordance was 93.8% (61 of 65) and positive concordance was 93.5% (29 of 31) (κ = 0.88, P > .99). Among 43 paired UCSF cell blocks and MNH tissue blocks, overall ER IHC concordance was 88.3% (38 of 43) and positive concordance was 90.5% (19 of 21) (κ = 0.77, P > .99). We compared 62 MNH cell block and tissue block pairs. Overall ER IHC concordance was 90.3% and positive concordance was 87.9% (κ = 0.81, P = .69). Conclusions.— Pairwise comparisons between ER IHC at MNH, on cell blocks and tissue blocks, with ER IHC at UCSF on cell blocks showed excellent concordance. We demonstrate that ER IHC on fine-needle aspiration biopsy specimens can be implemented in resource-constrained settings.

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Section: Discussionmentioning

confidence: 99%

Evaluating Estrogen Receptor Immunohistochemistry on Cell Blocks From Breast Cancer Patients in a Low-Resource Setting

Kimambo

Vuhahula

Mwakigonja

et al. 2020

Archives of Pathology &Amp; Laboratory Medicine

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“…Methods using thrombin clot or agar gel to stabilize the cell pellets have been reported. [ 23 24 25 26 ] We tried standardizing on these latter methods, but they gave unsatisfactory results in our setting. There were problems in wax embedding, resulting in rejection of these methods in favor of the basic method we have continued to use.…”

Section: Discussionmentioning

confidence: 99%

The value and limitations of cell blocks in endobronchial ultrasound-guided fine-needle aspiration cytology: Experience of a tertiary care center in North India

Bharati

Neha

Rao

et al. 2021

J Cytol

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Background: Endobronchial ultrasound (EBUS)-guided fine-needle aspiration cytology (FNAC) is recommended for diagnosing bronchial neoplasms and evaluating mediastinal lymph nodes. However, it may not be possible to subtype or definitely categorize many bronchial neoplasms on FNAC smears alone. Obtaining adequate diagnostic material is often a problem. In such cases, cell blocks made from FNAC material may serve as a useful adjunct. Aim: To study the value and limitations of cell blocks in adding diagnostic information to EBUS guided FNAC smears. Material and Methods: One hundred and eighty-five cases of EBUS guided FNAC having concomitant cell blocks were reviewed. The cases were evaluated for the extent of adequacy, of definite benign/malignant categorization and of definite subtyping in malignant tumors in these cases. The proportion of cases in which cell blocks added information to FNAC smears alone for the above parameters were calculated. Results: Cell blocks provided additional information in 31 out of 185 cases. Cell blocks were necessary for subtyping 24/59 malignant tumors, definite categorization into benign and malignant in 10/140 adequate samples, and increasing adequacy in 6/185 total samples. A total of 45 samples were inadequate in spite of adding information from cell blocks to smears. Conclusion: Cell blocks added clinically significant information to EBUS guided FNAC and should be used routinely. To make it more useful, alternative methods of cell block preparation (including proprietary methods) may be evaluated.

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“…Therefore, it is deemed essential to find materials to be used as adjuvants in the generation of CBs. Several common assisted embedding methods to prepare CBs have been developed, such as the plasma/thrombin (PT), 4–6 agar, 7 egg albumen, 8 sodium alginate, 9,10 and collodion bag methods, 11,12 among others. However, their protocols are often cumbersome and frequent low cellular yield is the leading cause of dissatisfaction 13 .…”

Section: Introductionmentioning

confidence: 99%

A novel method for making cell blocks with higher cellular yield

Liu

Huang

et al. 2022

Diagnostic Cytopathology

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Introduction Cytopathology is an important part of pathology that is used to diagnose disease on the cellular level. The application of the cell block (CB) technique plays a vital role in cytological diagnosis, as blocks and slides can be further used for special stains, immunohistochemistry (IHC), and molecular pathological analysis. Several methods for making CBs have been reported, but their procedures and cellular yield are still deemed unsatisfactory. In this article, we used gellan gum (GG) as an adjuvant for CBs, which resulted in higher cellular yield with simpler procedures. Methods CBs were prepared by using GG, copper sulfate, plasma/thrombin, or pregelatinized starch methods. The procedures of each of these four methods were then compared. CB sections were stained with hematoxylin and eosin (H&E), and the background and morphological features seen by H&E staining were compared. A preliminary IHC and fluorescence in situ hybridization (FISH) study was performed using cytology specimens from eleven and five cases, respectively. The expression of immunocomplex by IHC and the molecular signals detected by FISH were compared in CB sections made by the four methods and a section derived from the biopsy specimen block from the same patient. Feulgen staining, Alcian blue staining, and Masson trichrome staining were performed on the CB sections from 3 cases of pleural fluid. The cellular yield of CB sections from 83 cases according to the four methods was compared using NDP analysis software. Results The results demonstrated that sections derived from CBs made with GG had a clear background and good morphological features by H&E staining. The expression of immunocomplex by IHC and the molecular signals of FISH detection in the sections from CBs made by GG were accurately located just as those in biopsy sections from the same patient. The DNA, acidic mucus, and fibrin could be clearly identified through special stains in the CB sections. The procedures involved in the GG method were easily controllable and the coagulated gel increased the ease by which the CB was embedded and sectioned. Specifically, sections from CBs made by the GG method contained higher cellular yield because cells could be concentrated on the bottom of the gel after centrifugation. Conclusion This novel method for making CBs is a practical, simple method that can result in higher cellular yield. This method is therefore worth promoting in clinical applications.

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Modified Plasma-Thrombin Method of Cell Block Preparation for Fine-Needle Aspiration Biopsies in Resource-Limited Settings

Abstract: The modified plasma-thrombin method is a reliable cell block preparation method that can be easily applied in resource-limited settings.

Cited by 10 publications

References 36 publications

Evaluating Estrogen Receptor Immunohistochemistry on Cell Blocks From Breast Cancer Patients in a Low-Resource Setting

Evaluating Estrogen Receptor Immunohistochemistry on Cell Blocks From Breast Cancer Patients in a Low-Resource Setting

The value and limitations of cell blocks in endobronchial ultrasound-guided fine-needle aspiration cytology: Experience of a tertiary care center in North India

A novel method for making cell blocks with higher cellular yield

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