EUS Guided FNA Cell Block Cytology and Intraoperative Squash Cytology in the Diagnostic Approach of Unfamiliar Malignant Neoplastic Disorders.

Background and Aim: Endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) is a procedure of choice for the diagnostic evaluation of submucosal and periluminal lesions. Tissue sample can be obtained by EUS-FNA cytology (FNAC) or cell block (CB). The aim of the present study is to compare diagnostic yield of EUS-FNA CB and cytology in the absence of onsite pathologist following a protocol-based EUS-FNA approach in solid lesions. Patients and Methods: Participants who underwent EUS-FNA at our center for solid submucosal or periluminal lesions (pancreas, lymph node, and liver) between 2014 and 2016 were included, retrospectively. The indication for the procedure along with the clinical and other investigation details and the final etiological diagnosis were recorded on uniform structured data forms. The diagnostic yield of cytology and CB were compared using McNemar’s test. The P < 0.05 was considered statistically significant. Results: EUS-FNA for solid lesion was performed in 130 lesions in 101 patients during the study period. Their mean age was 52.5 ± 12 years and 42.5% were female. Pancreatic masses were the most common lesions (37.7%) followed by lymph nodes (36.9%). Submucosal lesions (17.7%) and liver lesions (7.7%) accounted for rest of the cases. The overall diagnostic yield for EUS-FNAC (70%) and CB (74.6%) was not significantly different (P = 0.3) and their combined yield was 85.3%. For the 23 patients with submucosal lesion, diagnostic yield of CB (82.6%) was significantly better than cytology (47.8%, P = 0.04). Conclusions: EUS-guided CB has better yield compared to cytology in gastrointestinal submucosal lesions. The combination of CB with cytology improves the overall yield of the procedure; and hence, they should be considered complimentary rather than alternatives.

Background and Objectives:Endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) is a procedure of choice for diagnostic evaluation of endoluminal and periluminal lesions. Tissue sample can be obtained by EUS-FNA cytology or cellblock (CB). The aim of the present study is to compare diagnostic yield of EUS-FNA CB and/or cytology in the absence of on-site pathologist following a protocol-based EUS-FNA approach in solid lesions.Methods:Subjects who underwent EUS FNA at our center were included in this 2-year retrospective study. The etiological, clinical, and investigation details were recorded on uniform structured data forms. Superiority of the yield was calculated by McNemar’s test for P value.Results:Pancreatic masses were the most common indications (34%), followed by nodes (29%) in 114 EUS-FNA solid lesions. The diagnostic yield for EUS-FNA cytology was 68%, CB was 77%, and combined was 81%. There was no statistical significance in the yield between cytology and CB. CB was superior in pancreatic neuroendocrine tumor, lymphoma, stromal tumors, and liver mass evaluations.Conclusions:EUS-FNA needles provide good specimen for CB, and combination of CB with cytology increases the yield. CB is preferred over cytology in selected patients.

Cytological smear and cell block (CB) are routinely used to diagnose non-gynaecologic specimens. However, there is scanty information in the literature to compare cytological smear and CB with the corresponding tissue biopsies. This study is aimed at evaluating the accuracy of cytological smear and CB in the diagnosis of malignant tumours in non-gynaecologic specimens. A total of 70 malignant cases were subjected to cytological smear and CB. Corresponding histopathology was also included. The most frequent immunomarkers found between CB and tissue biopsies were also correlated. Accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false positive and false negative values were analyzed for each method. The accuracy, sensitivity and positive predictive value for cytological smear were 92.8%, 100.0% and 92.9%, whereas for CB were 91.4%, 98.4% and 92.7%, respectively. In CB method, the accuracy, sensitivity and positive predictive value for CK7 were 88.9%, 91.7% and 95.6%, whereas for CK5/6 were 75%, 100% and 57.1%, respectively. Cytological smear and CB are very sensitive and accurate in the detection of malignant tumours in nongynaecologic specimens. Additional corresponding tissue biopsies should be re-evaluated.

Tumors arising from the posterior pituitary gland are rare and closely resemble pituitary adenoma in presentation and imaging. Most of them come as a histopathologic surprise. We have analyzed the posterior pituitary tumors managed in our institute and have discussed the dilemmas in imaging, challenges in intraoperative squash cytology, and surgical management. We retrospectively reviewed our operative database of pituitary tumors over the past 10 years, which included five posterior pituitary tumors (three granular cell tumors [GCTs] and two spindle cell oncocytomas [SCOs]). Clinical, imaging, and endocrine characteristics; intraoperative details; histopathologic features; and postoperative outcomes were collected and analyzed. The mean age of the patients was 47 years. All patients presented with varying degrees of vision loss. Radiology revealed a sellar / suprasellar lesion with the pituitary gland seen separately in two of three GCTs, whereas a separate pituitary gland could not be identified in both the SCOs. Pituitary adenoma was a radiologic diagnosis in only two of five cases. Three patients underwent a transsphenoidal surgery, whereas two underwent surgery by the transcranial approach. Intraoperative cytology was challenging, though a possibility of posterior pituitary tumor was considered in three of four cases, whereas one was considered meningioma. All the tumors were very vascular and influenced the extent of resection. GCTs and SCOs are relatively uncommon tumors that are difficult to diagnose on preoperative imaging. Intraoperative squash cytology too can pose challenges. A preoperative suspicion can prepare the surgeon for surgery of these hypervascular tumors. The transcranial approach may be necessary in cases of uncertainty in imaging.

Intra-operative cytology is an important diagnostic tool. It has shown to play an important role especially in the diagnosis of central nervous system tumours. The study was done to assess the feasibility of squash cytology as standalone diagnostic test in setting where frozen section facility is not available. Total 48 patients with various intracranial lesions were initially enrolled in the study. Patients were investigated by various radio-imaging techniques and routine blood investigations. Forty-one patients were operated at Netaji Subhash Chandra Bose medical college, Jabalpur. Intra-operative squash cytology diagnosis was performed and was correlated with histology diagnosis as gold standard. Out of 41 patients, inflammatory lesions were diagnosed in nine patients while benign lesions [most common neurilemmoma and meningioma] were observed in 21 and malignant lesions [astrocytoma was most common] were diagnosed in 11 patients. Diagnostic accuracy of intra-operative squash cytology irrespective of lesion & site was 95%. We were able to inform about the diagnosis to neurosurgeon in 15 minutes in all cases and within 12 minutes in >85% cases Squash smear cytology is reliable and rapid standalone diagnostic method and it can assist for intra-operative decision-making diagnosis of intracranial lesions in resource-limited settings where frozen section facility is not available.

Objectives:Endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) is an effective method to acquire tissue from the mucosal, submucosal, and peri-intestinal structure with the pancreas being the most common organ to be targeted. This study is aimed to evaluate the role of EUS-FNAC in pancreatic lesions as well as other gastrointestinal (GI) structures including lymph nodes, upper GI tract, liver, and spleen.Material and Methods:A total of 71 cases were taken in which EUS FNAC was performed over 19 months (2018–July 2019). The details analysis of the cytological features was performed in all these cases along with the clinical outcome. The diagnostic efficacy of the EUS-FNAC was evaluated in these cases.Results:Out of 71 cases, 36 (50.7%) were male. The most common site being the pancreas 45 (60%) followed by intra-abdominal lymph nodes in 13(17.3%) cases and stomach 7 (9.3%). The neoplastic aspirate was noted in 38 (50.7%) cases. Among malignant lesion, adenocarcinoma was the most common; however, uncommon malignancies such as metastatic malignant melanoma and acinar cell carcinoma were also noted. Malignant lesion in pancreas includes adenocarcinoma (n = 11, 24.4%) followed by neuroendocrine tumor (n = 7, 15.6%). Tuberculosis was one of the common benign lesions to be reported.Conclusion:EUS-FNAC is an effective tool in the diagnosis of GI lesion particularly in the pancreas where it can avoid unnecessary surgical intervention in advanced malignancies. It can effectively obtain samples for molecular markers for pancreatic cancers. Nonetheless, diagnosing tuberculosis in inaccessible lymph nodes with its help is a lifesaving approach especially in developing countries.

We assessed whether intraoperative squash cytology could provide surgeons with a qualitative diagnosis of brain lesions when frozen section diagnosis is equivocal. The study included 51 lesions that were diagnosed intraoperatively as equivocal brain tumour on the basis of frozen section. We retrospectively classified the lesions into five groups according to the final histopathological diagnoses (I: malignant lymphomas; II: diffuse astrocytic and oligodendroglia tumours; III: pituitary adenomas, IV: metastatic carcinomas; V: others). We assessed the squash cytology features of Groups I-IV and of the specific lesion types, and compared features among the groups. The four groups differed in a range of salient cytomorphological features: lymphoglandular bodies in Group I (eight of nine cases), cytoplasmic fibrillary processes in Group II (six of eight cases), low-grade nuclear atypia in Group III (seven of seven cases), and large nuclei (approximately 80μm2 ) and nuclear crush artefacts in Group IV (seven of nine cases). Findings of lymphoglandular bodies on intraoperative squash cytology can be considered characteristic of malignant lymphomas, while cytoplasmic fibrillary processes indicate diffuse astrocytic and oligodendroglial tumours. We conclude that squash cytology could yield a qualitative intraoperative diagnosis in over 25% of cases for which frozen section yields a diagnosis of equivocal brain tumour.

Introduction: The cytological examination of ascitic fluid is widely recognised and well-documented for its importance in staging and prognosis of malignancy, and for providing information about inflammatory lesions. The Cell Block (CB) method offers improved architectural patterns and morphological features, aiding in the differentiation between reactive mesothelial cells and malignant cells, thus enhancing the efficacy of cyst diagnosis. Additionally, the CB technique finds applications in molecular biology and immunocytochemistry, making it advantageous for targeted therapy due to its ability to preserve cytological material. Aim: To compare the accuracy of conventional cytology smear technique and CB from ascitic fluid with histopathology for diagnosing ovarian tumours. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India. A total of 45 patients with suspected ovarian tumours or presence of ascites were included. Biopsy samples were sent to the pathology laboratory for histological evaluation, while study samples were collected from the Department of Pathology between January 2021 and December 2022. Sample processing techniques, such as conventional cytology {including cytocentrifugation before Giemsa, Pap, and Haematoxylin and Eosin (H&E) staining} and thromboplastin-plasma technique for CB preparation, were employed. Evaluation parameters included comparing morphological features of frequently stained cytology smears and CB technique of ascitic fluid, along with their concordance with histopathological diagnosis. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) program for Windows, version 28.0. Results: Among 45 patients, majority 24 (53.40%) of them belonged to 41-60 years of age group. It was noted that 24 (53.40%) patients had ascites, 11 patients (24.40%) had abdominal pain with ascites, and 10 (22.20%) had ovarian mass with ascites. Conventional cytology smear diagnoses revealed that 22 (48.9%) patients had infiltrates of serous cystadenocarcinoma. A significant correlation was found between the findings of the CB and Conventional Smear (CS) (p=0.0001), with a sensitivity of 94.12%, specificity of 100%, Positive Predictive Value (PPV) of 100%, Negative Predictive Value (NPV) of 85.71%, and a diagnostic accuracy of 95.65% for CB correlating with CS. Conclusion: A combined strategy utilising stained cytology smears and the CB technique of ascitic fluid could be considered in the diagnostic approach for malignant ovarian tumours.

This study was undertaken to compare the efficacy of cytologic smears and histological sections from cell blocks in diagnosis of space occupying lesions (SOLs) of the liver and to classify the lesions on the basis of combined cytohistologic diagnosis. The study was conducted on 50 patients who had radiologically detected SOL/SOLs in the liver and ultrasound-guided fine needle aspiration of liver was done. In all the cases, both smears and cell blocks were made. Forty-seven cases were diagnosed as malignant and three as benign on both cytologic smears and cell blocks. Hepatocellular carcinoma was diagnosed in 8 (16%) cases and metastasis in 39 (78%) cases. The subtyping of malignancy could not be done on 11 (22%) cytologic smears and 8 (16%) cell block sections. However, on combined cytohistologic correlation, 17 (34%) out of these 19 (38%) cases could be subtyped. Sensitivity of cytologic smears and cell blocks in subtyping of malignancy was 72.3% and 82.9%, respectively. Combined cytohistologic diagnosis was found to be significantly better than isolated cytologic and cell block diagnosis (P < or = 0.05). To conclude, FNA of the SOLs of the liver is an effective procedure for diagnosing malignancy. However, cytological examination alone may fail to pinpoint the type of the tumor. Concomitant examination of cell block not only confirms the malignancy but also helps in subtyping it.

Increasing the specimen adequacy of transpedicular vertebral body biopsies. Role of intraoperative scrape cytology

Objectives The diagnostic efficacy of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) of pancreatic solid masses varies widely depending on the presence of rapid onsite evaluation (ROSE) and the type of cytology preparations. The present study aims to compare the diagnostic efficacy of cytology smears (CS) and cell block (CB) with ROSE versus Thinprep slides (TpS) with CB without ROSE in diagnosing pancreatic solid masses. Methods Performed retroprospective review of 56 patients (2017-2018) with surgically confirmed pancreatic neoplasms including cytology preparation type and comparison of diagnostic efficacies. Results Out of 56 patients who underwent surgical resection, 30 patients were diagnosed with pancreatic ductal adenocarcinoma (PDAC) and 26 with pancreatic neuroendocrine tumor (PNET) or solid pseudopalliary neoplasm (SPN). Out of 30 surgically removed PDACs, 20 patients had prior cytology specimens while 10 had surgical core biopsies. Of the 20 cytology specimens, 12 patients had ROSE with concurrent CS and CB, and all cases were diagnosed as positive. Out of the 8 patients without ROSE, 3 patients (1 with bile duct brush, 2 with TpS and CB) were diagnosed as positive. The diagnostic efficacy was 100% (12/12) in patients with ROSE and CS compared to 37.5% (3/8) in patients without ROSE. In 26 non-PDAC cases, 21 patients had cytology specimens and 5 had surgical biopsies. Seventeen cases with ROSE and immunohistochemical stains (IHC) on CB were diagnosed as positive, while 4 cases without ROSE and IHC received atypical diagnoses, resulting in a decreased diagnostic efficacy from 100% (17/17) to 0% (0/4). Conclusion ROSE with CS and CB are superior to TpS and CB in diagnosing solid pancreatic masses. ROSE with IHC on CB is crucial for diagnosing PNET and SPN, while CS and CB are important for PDAC diagnosis.

Endoscopic ultrasound-guided fine-needle aspiration cytology in pancreaticobiliary carcinomas: diagnostic efficacy of cell-block immunocytochemistry

Neurohypophysis granular cell tumor (NGCT) is a rare entity and is classified under thyroid transcription factor 1 (TTF-1) expressing tumors of pituitary. It is considered as an uncommon differential during sellar and suprasellar mass evaluation. Its intraoperative squash cytology is distinct and has rarely been reported in literature. A 65-year-old female presented with reduced vision of right eye and history of seizures. Radiological findings revealed a sellar/suprasellar mass with mass effect on optic chiasma. Intraoperative squash neurocytology examination showed a spindle cell lesion with abundant granular cytoplasm in tumor cells. Subsequent histopathology and immunohistochemistry confirmed the diagnosis of granular cell tumor. Granular cell tumor remains one of the sellar/suprasellar surprises. Its intraoperative neurocytology is unique and should be considered while evaluating a sellar/suprasellar mass. A case of sellar granular cell tumor with its intraoperative squash cytology, histopathology along with a review of literature is being presented with special emphasis on cytological differential diagnosis in pituitary region.

BackgroundThe diagnostic efficiency of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) cytology varies widely depending on the treatment method of the specimens. The present study aimed to evaluate the diagnostic efficacy of cell block (CB) immunohistochemistry, smear cytology (SC), and liquid-based cytology (LBC) in patients with pancreatic lesions without consulting an on-site cytopathologist.MethodsThis study prospectively enrolled 72 patients with pancreatic lesions. The EUS-FNA specimens were examined by SC, LBC, and CB immunohistochemistry. The diagnostic efficacy of the 3 methods was then compared. Patients’ final diagnosis was confirmed by surgical resection specimens, diagnostic imaging, and clinical follow-up.ResultsOur results included 60 malignant and 12 benign pancreatic lesions. The diagnostic sensitivity (90%), negative predictive value (66.7%), and accuracy (91.7%) of CB immunohistochemistry were significantly higher than those of SC (70.0%, 30.0%, and 75.0%, respectively) and LBC (73.3%, 31.6%, and 77.8%, respectively) (all P<0.05). The combination of CB and SC, or CB and LBC, did not significantly increase the efficacy compared to CB immunohistochemistry alone.ConclusionOur findings suggest that in the absence of an on-site cytopathologist, CB immunohistochemistry on EUS-FNA specimens offers a higher diagnostic efficacy in patients with pancreatic lesions than does SC and LBC.

Background: Fine needle aspiration cytology of superficial lesion or deep anatomical site is an increasingly common procedure in diagnosis of neoplastic lesions. Sometimes fine needle aspiration does not yield sufficient information for precise diagnosis and the risk of false negative or intermediate diagnosis always exists. In order to overcome these problems, cell block technique has been resorted to make the best use of available material.Materials and Methods:This was a prospective hospital based study conducted in the department of pathology, Manipal Teaching Hospital, Pokhara, Nepal over a period of 2 years from the year 2009 October to 2011. There were total of 49 cases included in the study of which fine needle aspiration cytology smears, cell block and biopsy specimens were available.Results: A total of 49 such cases were included in the study of which fine needle aspiration cytology smears, cell block and biopsy specimens were available. Of all the malignant cases, 12 cases were from lungs aspirate, 10 were from breast, 15 from lymph node and 12 from thyroid. With the combined use of smear and cell block, the diagnostic accuracy of the tumors approaches 100% and also significantly improves diagnostic and sub typing accuracy of malignancies. Cell blocks were found superior in diagnosing neoplasm than smears with diagnostic accuracy of 95.91% and 91.8% respectively.Conclusion: Cell block method allows the recovery and processing of minute amounts of cellular material and facilitates the better classification of tumor when reviewed along with cytological smears. The method is simple to perform and no expertise is required to handle the specimen. Therefore the routine preparation of the cell block improves the accuracy of fine needle aspiration cytology diagnosis.Journal of Pathology of Nepal (2012) Vol. 2, 272-276DOI: http://dx.doi.org/10.3126/jpn.v2i4.6876