Cell Block Study Research Articles

Concordance between conventional cytology and cell block of suspected malignant pleural effusion: A record-based study in a tertiary care center of eastern India

Background: Cytological study of pleural fluid helps establishing the underlying cause of pleural effusion. It is considered the most important tool in diagnosing malignancy in effusions. However, accurate identification of cellular morphology can be a problem in conventional cytology. Cell block preparation from pleural effusion aids in this diagnosis due to the preservation of tissue architecture, and multiple sections can be obtained for further studies. Aims and Objectives: The objectives of this study were to compare the diagnostic results of conventional cytology and cell block studies of suspected malignant pleural effusions and find out the diagnostic agreement or concordance between the two methods. Materials and Methods: A record-based study was conducted at the Department of Pathology on conventional cytology and cell block study reports of 150 suspected malignant pleural effusion cases over 35 months. The diagnoses were expressed in five categories – non-diagnostic, negative for malignancy, atypia of undetermined significance, suspicious for malignancy, and malignant. χ2 test was used to identify the percentage of malignancy reported. Agreement of both methods was assessed through Kappa statistics. Results: About 4.67% of cases were reported as malignant by conventional cytology, whereas cell block study diagnosed malignancy in 19.33% of cases. Relative diagnostic agreement between the two methods was 0.73 and concordance by Cohen’s Kappa was 0.34, which signifies fair concordance. Conclusion: Cell block study, though having a fair concordance, is much superior to conventional cytology smears in detecting malignant cells and diagnosing a pleural effusion as malignant.

A single tertiary institution review of the international system for serous fluid cytopathology and the impact of cell block and ancillary studies on its performance.

We sought to assess the utility of the International System for Serous Fluid Cytopathology (TIS) in the context of our department's routine practice. We examined 1028 archived effusion cytology (pleural, peritoneal, and pericardial) cases from 2018 to 2019, and re-classified them along the international system into the following diagnostic categories: nondiagnostic (ND), negative for malignancy (NFM), atypia cells of undetermined significance (AUS), suspicious for malignancy (SFM), and malignant (MAL). The full distribution of the cases examined was as follows: ND 2.0%; NFM 66.1%; AUS 6.0%; SFM 4.7%; MAL 21.2%. Overall risk of malignancy for each category was calculated as: ND 30.0%; NFM 18.0%; AUS 61.9%; SFM 100%; MAL 94.4%. The overall performance attributes of TIS were as follows: sensitivity 57.1%; specificity 98.3%; positive predictive value 94.4%; negative predictive value 82.0%; diagnostic accuracy 84.5%. The new classification was simple and intuitive to use and our results appear to fall within the expected ranges of the new guidelines, with risk of malignancy and accuracy comparable to similar studies. The availability of a cell block allowed for refinement of the diagnosis in a majority of cases with equivocal cytology, though this was dependent on the cell yield.

Comparison of Diagnostic Yield and Complications in Ultrasound-Guided Closed Pleural Biopsy Versus Thoracoscopic Pleural Biopsy in Undiagnosed Exudative Pleural Effusion.

IntroductionMalignancy, tuberculosis, and non-tubercular pleural infections account for most exudative pleural effusion. Pleural fluid cytology, biochemical tests and even pleural fluid cell block studies may fail to yield a diagnosis in certain cases. Medical thoracoscopy is the gold standard for the diagnosis of unexplained pleural effusions. However, access to medical thoracoscopy may be limited, particularly in developing countries. Also, certain patients may not be fit to undergo the procedure because of medical conditions. An ultrasound-guided pleural biopsy is an option in such conditions. The present study is intended to compare the diagnostic yield and complications of both methods of pleural biopsy in undiagnosed exudative pleural effusion under a randomized controlled trial.MethodAfter fulfilling all the inclusion criteria, participants were randomized to either ultrasound-guided closed pleural biopsy or thoracoscopic-guided pleural biopsy groups. The primary outcome was to compare the diagnostic yield of ultrasound-guided Tru-Cut® (Newtech Medical Devices, Faridabad, India) closed pleural biopsy versus thoracoscopic pleural biopsy, and the secondary outcomes were to compare the complications rate, duration of the procedure, and hospital stay in the patients undergoing ultrasound-guided pleural biopsy versus thoracoscopic pleural biopsy, and predictors of a positive biopsy result in both groups.ResultA total of 118 patients with pleural effusion were screened; 39 of them who were eligible, randomized into the ultrasound group (20 patients) and the thoracoscopic group (19 patients). The median age of participants was 53.5 (50-58) years and 55 (45-64) years in the ultrasound and thoracoscopic groups, respectively. Pleural fluid cell count, protein, adenosine deaminase (ADA), and lactate dehydrogenase (LDH) were similar in both groups, although pleural fluid glucose was low in the ultrasound group. Diagnostic yield was 90% (18/20) and 94.7% (18/19) in the ultrasound and thoracoscopic groups, respectively, which was statistically non-significant (p=0.963). The median duration of hospital stay was 9.5 (5.3-27) days and 15 (12-22) days in ultrasound and thoracoscopic groups respectively. The thoracoscopic group had a more prolonged stay compared to the ultrasound group, but it was statistically non-significant (p=0.09). The duration of the procedure was significantly longer in the thoracoscopic group 90 (85-105) minutes, in comparison to ultrasound 47.5 (41.3-55) minutes (p=0.001). No major complications were seen in both groups. Subcutaneous emphysema was the most common complication in the thoracoscopic group (10%), followed by hemorrhage (5.3%), and respiratory failure (5.3%). Hypotension was the only complication in the ultrasound group (5%). The rate of complications was significantly higher in the thoracoscopic group (p<0.01).ConclusionUltrasound-guided closed pleural biopsy is as good as thoracoscopic pleural biopsy in undiagnosed exudative pleural effusion. It was associated with a shorter procedure duration, a shorter hospital stay, and fewer complications as compared to thoracoscopic biopsy. Both the procedures were safe in experienced hands and a hospital setup, but the thoracoscopic pleural biopsy was associated with complications.

Correlation of fine needle aspiration cytology and cell block study of category III, IV, and V (TBSRTC-2017) thyroid lesions with special reference to cytokeratin-19 immunohistochemical staining.

Ascertaining the role of cytokeratin-19 (CK19) and its staining pattern helps to differentiate papillary carcinoma from other thyroid lesions. To correlate fine needle aspiration cytology (FNAC) and cell block study of equivocal cases (Category III, IV, and V) with the role of CK19 staining in it. A hospital-based cross-sectional observational study was designed and conducted at North Bengal Medical College and Hospital, Shusrutnagar, Darjeeling. The FNAC performed and reported as per TBSRTC-2017.50 cases of Category III, IV, and V was selected for cell block study and CK19 staining followed by immunohistochemical scoring. Out of 50 cases, 17 were follicular neoplasm, 21 papillary carcinoma, 6 lymphocytic thyroiditis, 1 Hürthle cell adenoma, 1 medullary carcinoma, 1 lymphoma, and 3 undifferentiated carcinomas. Among cases of papillary carcinoma, 10 showed 4+ positivity, 9 showed 3+ positivity, 2 showed focal 1+ and 2+ positivity. In the case of follicular neoplasm, 1 showed 3+ positivity, 3 cases had 1+ 2+ positivity, and 13 cases revealed negative staining. Role of CK19 in distinguishing papillary carcinoma of thyroid from other lesions in cytologically diagnosed Category III, IV, and V (TBSRTC-2017) cases can be demonstrated.

CORROBORATION OF FINE NEEDLE ASPIRATION CYTOLOGY FINDINGS WITH CELL BLOCK STUDY OF MALIGNANT LUNG LESIONS USING IMMUNOSTAINS (TTF1, NAPSIN A, P40 AND CHROMOGRANIN A).

Background: Malignancy of the lung has been rising steadily worldwide and exact sub typing has become a necessity for targeted therapy. FNAC alone has its limitations in sub categorization of lung malignancy because of lack of architecture. Cell block preparation from FNAC material with immunohistochemistry panel would supplement the FNAC nding. Objectives: To determine the utility of cell block study using immunostains (TTF 1, Napsin A, p40 and Chromogranin A) in corroborating the ndings of FNAC in the study of malignant lung lesions. Materials and methods: A hospital based cross sectional study was done on the FNAC sample from lung masses followed by cell block study and immunohistochemical staining for (CHROMOGRANIN A, NAPSIN A, p40, TTF1). Data was analyzed using IBM SPSS statistics version 21 Software. Results: A total of 32 (54.2%) cases were found malignant and 27 (47.3%) cases were found benign. A total 59 cell block were prepared from 32 cases positive for malignancy (PFM) and 27 cases negative for malignancy(NFM). After cell block and immunohistochemical studies, 2 benign lesion were recategorized as malignant and 3 malignant cases recategorized as benign lesion. There was a substantial agreement found between FNAC diagnosis and IHC diagnosis as in both cases the kappa value (฀ coefcient) were found to be 0.747 (between 0.61 - 0.80). Conclusion: The cell block from the aspirated material revealed further architectural and immunohistochemical features which not only conrmed the FNAC diagnosis but helped to recategorize 2 benign and 3 malignant lesion.

Role of liquid-based cytology and cell block study of pleural fluid in the evaluation of cases of malignant Pleural effusion with special reference to immunohistochemistry

Introduction: Lung cancer is the most common primary tumor associated with malignant pleuraleffusion (MPE). In this study, we aim to use cell remnants for cell block preparation after performingliquid-based cytology (LBC) of effusion fluid. Immunohistochemistry was helpful to evaluate thosecases having diagnostic dilemmas in LBC and cell block. Method: It was a cross-sectional,prospective, single institution-based study, conducted in the department of Pathology incollaboration with the Department of Respiratory Medicine IPGMER &amp; SSKM Hospital, from January2018 to June 2019 in the institution. Result: Most of the study population were in between the agegroup of 51 to 60 years with male predominance and with fever and cough being the predominantsymptoms. Liquid-based cytology was positive for malignancy in 58% of cases and suspicious ofmalignancy in 22% of cases of malignant pleural effusion and it had 95.35% sensitivity, 58.82%specificity in diagnosing malignant pleural effusion.LBC was done followed by cell block preparationsare studied further by Immunohistochemistry. Discussion: Morphological features were betteridentified by the cell block method when compared to LBC. Multiple sections can be obtained forspecial stain or IHC study which bridges the gap between cytology and histology.

EVALUATING EFFICACY OF CYTOLOGICAL DIAGNOSIS OR SEROUS EFFUSIONS BY SMEAR CYTOLOGY AND CELLBLOCK TECHNIQUE

Introduction :- Cytological examination of serous effusions is of paramount importance not only for diagnosing cancer, but it may also reveal information regarding various inammatory conditions, parasitic infestations, infection with bacteria, fungi or viruses, and some immunological diseases. Cellblock technique has many advantages over conventional smear cytology in improving the sensitivity of diagnosis. The main advantages of the cellblock technique are preserving tissue architecture and obtaining multiple sections from the same material for special stains and immunohistochemistry. Objectives :- To study the body uids, i.e., pleural, peritoneal, and pericardial, for the absence of local or systemic pathological situation. To evaluate the diagnostic efcacy of a combined approach of conventional smear study and cellblock technique in serous effusions. Methods:- A total of 100 uid samples from referral centers received in the Cytology section, After preparing two conventional smears for PAP and Giemsa stains, the residual sample was subjected to cellblock preparation. Nathan's Alcohol Formalin Substitute was added and xed for an hour. After xation, the specimen was centrifuged at 1500 rpm for 15min.The supernatant was decanted, and the sediment completely drained off by XIinverting tube over Whatman lter paper. After discarding the supernatant xative, the pellet formed was removed with a pointed spatula and placed on top of the lens paper inside the tissue cassette, and processed for parafn embedding. Results:- In the total of 100 samples were subjected for cytological evaluation. Pleural uids were 47%, peritoneal uids were 43%, and pericardial uids were 10%. Maximum samples were in age group of 41-50 years. By Conventional smear cytology, benign, suspicious and malignant lesions were 76%, 14.5%, and 9.5%, respectively. By cellblock study, benign and malignant lesions were 75.5% and 24.5%, respectively. Conclusion:- Morphological features were better appreciated by cellblock composition, which risen the sensitivity of cyst diagnosis hence serves as a useful adjunct to conventional smears.

Diagnostic utility of rapid on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration samples: A study in a region of high tuberculosis burden.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a very useful tool for precise diagnosis of thoracic lesions. However, the procedure sometimes has a poor yield. Rapid on-site evaluation (ROSE) in EBUS-TBNA has been shown to be helpful to improve its diagnostic yield and minimise the need for repeat procedures. Most of the studies that have evaluated the utility of ROSE have focused on malignant lesions; however, it is important to understand its utility in benign lesions, particularly in a country with a high tuberculosis burden. This study was undertaken to evaluate the utility of ROSE in EBUS-TBNA for the diagnosis of patients presenting with mediastinal lymphadenopathy and/or thoracic mass for benign and malignant pathologies. This was a prospective study including 47 patients who underwent EBUS-TBNA for thoracic lesions (lung masses and hilar/mediastinal lymphadenopathy) over a 10-month period at a single tertiary care centre. In addition to ROSE and definitive cytology, the aspirated material was also sent for cell block and microbiological studies. Endobronchial/transthoracic biopsy was conducted for histopathological evaluation (HPE) where required, at the discretion of the clinician. ROSE diagnosis was then compared with the final diagnosis. Of the 47 patients examined using ROSE, granulomas were observed in 33 cases, non-specific inflammation in six cases, and malignancy in five cases; one case was inconclusive and the sample was found to be inadequate in two cases. The ROSE assessment matched the final diagnosis in 84.45% patients. ROSE is a simple procedure that is able to provide an immediate and accurate assessment of adequacy and has a significant yield, enabling a preliminary diagnosis to be made in both benign and malignant samples.

Diagnostic Significance of Fine Needle Aspiration Smear and Cell Block Study in Skin and Subcutaneous Nodules

Background: Evaluation of patients with skin or subcutaneous nodules, especially if it was multiple represents a major problem for the clinicians. But with full investigations, the problem becomes easier. However, the final diagnosis depends on pathological reports of tissue biopsy [1]. The easy access of the skin nodule provides the soil for performance fine needle aspiration cytology and taking the samples by the pathologists, or the clinicians. Smear cytology gives many defaults[2]. Performance of cell blocks was a trial to avoid these defaults and improve the diagnosis. The results of smear and cell block examinations were compared with examination of tissue biopsies. Methodology: Two hundred twenty five skin and subcutaneous nodules from 225 patients underwent the material of this study. The patients were selected from those referred topathology department, faculty of medicine Zagazig University, through the period between January 2018 and December 2020. Fine needle aspirations were performed utilizing the ordinary 22-gaugeneedle 10 cc syringes. Cell blocks were done utilizing the remnants in the syringe after performance of the smears. Histopathological examination was done using biopsies taken later on. Results: According to tissue biopsy examination: Benign lesions constitute the commonest findings (180 cases) 80% 0f cases: Lipoma35 cases (15.5%), Adipose tissue30 cases (13.3%), Fibrolipoma 20 cases (8.8%), Fibroma20 cases (8.8%), Juvenile fibroma 5 cases (2.2%), Neurofibroma 5 cases (2.2%), Sebaceous cyst in 25 cases (11.1%), Implantation cyst, or dermoid cyst 20 cases (8.8%), Pilomatrixoma 5 cases (2.2%), Seborrheic keratosis 10 cases (4.4%), Madura foot (actinomycosis) 5 cases (2.2%). Intermediate lesions: Atypical lipoma 5 cases (2.2%). Malignant lesions 25 cases (11.11%): Basal cell carcinoma10 cases (4.4%), squamous cell carcinoma 10 cases (4.4%), Basosquamous cell carcinoma 5cases (2.2%). For the FNAC smear examination, the sensitivity test was: 83.01%, the specificity test was: 16.66%. For the cell blocks examination, the sensitivity test was: 97.77%, specificity test was: 100%. Conclusion: Smear cytology is an easy, rapid test for diagnosis of skin nodule and performance of cell blocks improves its sensitivity and specificity outcome, but both must be attempted, because smear may be inefficient for some cases while cell block cannot be performed others.

Cytologic analysis of body fluids with an emphasis on malignant effusions

Introduction: Fluid cytology, a relatively non invasive technique, throws light on both malignant and non malignant causes of effusions. It especially contributes in cancer research and staging of various tumors. Materials and Methods: This was a retrospective study done over a period of two years from January 2014 to December 2015 in the department of Pathology, Kamineni Academy of Medical Sciences and Research Centre, Hyderabad. The body fluids included in the study were pleural, peritoneal, pericardial and synovial fluids. All other fluids were excluded. The relevant clinical data was noted. Gross, cell count and cytomorphological examinations of fluid were done. Results: Out of 302 cases, pleural fluids, 148 (49.0%) cases, were most common, followed by peritoneal fluid, 125 (41.39%) cases and least common was pericardial fluid, 8 (2.64%) cases. The maximum numbers of cases was in 5th decade. The age range was 3 years to 84 years. Female preponderance was observed with M: F ratio of 1: 1.17. Lymphocyte rich exudates were most common in pleural effusion. In peritoneal and pericardial effusions, transudates were more and suppurative inflammation was predominant in synovial fluid analysis. Over all, malignant effusions constituted 18.54% of effusions. Metastatic adenocarcinoma was the commonest malignancy detected in all body cavity effusions. Conclusions: Fluid cytology is relatively painless, simple, cost effective, rapid technique that yields quick and reliable results. Some cases may present major interpretative challenges to the pathologist. Ancillary studies such as cell count, biochemical, microbiologic evaluation, cell block and immunohistochemistry (IHC) study help in accurate identification of diagnosis. Keywords: Body fluids, Malignant effusions, Transudates.

Cytology Microarray on Cell Block Preparation: A Novel Diagnostic Approach in Fluid Cytology.

Background:The cytological examination of serous body effusions to diagnose and stage malignancy is well accepted in clinical medicine. Conventional smear (CS) and cell block (CB) study has to be complemented with immunohistochemistry (IHC) for a definitive diagnosis of malignancy and also to differentiate it from reactive mesothelial cells. Cytology microarray (CMA) is a modification of tissue microarray which involves core needle biopsy of multiple cell blocks and embedding it in a single block.Aim:The aim of this study was to assess the effectiveness of IHC technique in CMA for rapid diagnosis of malignancy and to reduce the cost of testing.Materials and Methods:In this study, 82 pleural fluids were collected and subjected to CS and CB study followed by IHC in CMA blocks. Six commonly used antibodies were applied to confirm malignancy and diagnose the primary.Results:Nineteen cases were diagnosed as malignancy by CB method. MOC-31 confirmed adenocarcinoma deposit in 67% cases of which 44% were proved to be of lung primary by TTF1.Conclusions:IHC on CMA blocks of effusion fluids is a very effective technique that can significantly reduce the cost of testing by >70%.

A comparative cytology and cell block study of malignant effusions

A comparative cytology and cell block study of malignant effusions

Endoscopic ultrasound-guided fine-needle aspiration cytology in the diagnosis of leiomyomas of the gastrointestinal tract

We investigated the efficiency and accuracy of endoscopic ultrasound-guided fine-needle aspiration cytology (EUS-FNAC) in the diagnosis of gastrointestinal leiomyoma (GIL). Between January 2009 and May 2018 we performed 795 EUS-FNAC studies of lesions of the gastrointestinal (GI) tract for various clinical indications. A diagnosis of GIL by cytological and cell block study was made in 14 patients (57.1% males, mean age 53.6 years, range 22–84 years). 7 tumors (50%) were detected incidentally. The lesions ranged in size from 2 to 10cm (mean size 4.4cm). The location of the tumors was: esophagus 7 (50%), stomach 6 (42.9%) and rectum 1(7.1%). The mean size of the symptomatic tumors was 5.2cm (range 3–10cm). The follow-up of the 14 patients varied from 1 to 108 months (median 39.5 months), during which no recurrence or evidence of lesion progression was observed. Imaging alone was not sufficient for an accurate diagnosis to be made. The pathological diagnosis was based on a combination of cytological, histopathological, and immunohistochemical features. The intracytoplasmic eosinophilic globule is a useful marker of paucicellular GIL differentiating it from gastrointestinal stromal tumor and leiomyosarcoma. EUS-FNAC is a reliable, accurate, and safe method for the diagnosis of GIL.

Cytomorphological features of cystic neutrophilic granulomatous mastitis on ThinPrep.

Granulomatous mastitis (GM) is an uncommon entity and challenging to distinguish from breast carcinoma, both clinically and upon imaging. Cystic neutrophilic granulomatous mastitis (CNGM) is a histologically distinct GM with clear "cystic" spaces (CS) surrounded by neutrophils and may contain Gram-positive bacilli (such as Corynebacterium species). Cytologic features of GM, in particular CNGM, on ThinPrep (TP), are limited. We reviewed the cytological features of GM with a special focus on CNGM on TP. Ten cases with a concurrent/recent FNA and histologic diagnosis of GM or CNGM, or positive culture for Corynebacterium kroppenstedtii, were identified over an 11-y period (2007-2017). A double-blinded review of the TP slides was performed by two independent cytopathologists. Data were analysed using Fisher's exact test. Six cases were histologically proven CNGM and 1 FNA only case had a positive culture for C. kroppenstedtii. Three had a histological diagnosis of GM. TP from the 7 CNGM cases demonstrated CS, including 1 case with a cellblock (CB) study showing well-formed clear CS, while none of the non-CNGM cases had CS (P = .01). Bacteria were identified within CS in 5 of 7 cases of CNGM. Multinucleated giant cells, granulomas, histiocytes, and neutrophils were variably observed. All histologically confirmed cases of CNGM showed distinct CS on TP. Cellblock study is a valuable adjunct to evaluate CNGM and for ancillary studies. Although our study was limited by a small sample size, our findings necessitate the need for studies with a larger cohort.

Cell blocks in cytopathology: An update.

The cell block (CB) offers many advantages over other cytological preparations, particularly for immunocytochemical and molecular testing. However, inconsistent cellularity remains the most common reason for dissatisfaction among cytopathologists. In recent years, there has been a surge in the demand for CBs imposed by the increasing number of minimally invasive procedures performed to obtain material for diagnostic, prognostic and predictive purposes from advanced stage cancer patients. However, routine preparation of CBs significantly increases laboratory work load, operating cost and sample turn-around time. The objectives of our review were to: (a) identify scenarios where a CB is likely to improve diagnostic yield; (b) optimise CB preparatory methods; and (c) understand the factors influencing the success and validity of ancillary testing on various types of CBs. We performed an extensive literature search on CBs in cytology on internet search engines using the following keywords: cell block, cytoblock, cytology, cytopathology, methods, preparation, fixatives, diagnostic yield, ancillary and molecular studies. New CB methods, improvisations of previous CB methods, their utility for diagnosis, immunocytochemistry and molecular testing, and role in predictive biomarker testing are discussed in this review. CBs of good quality and cellularity outperform other cytology preparations in their reliability and versatility for ancillary testing. With many CB methods described in the literature, each with specific advantages and limitations, laboratories may choose to use one or more of the methods depending upon their infrastructure, expertise and workload.

Uterine pleomorphic leiomyosarcoma with osteoclastic giant cells: Case report with peritoneal washing cytology and cell block study

Uterine leiomyosarcoma (LMS) with osteoclastic giant cells (OGCs) is extremely rare. However, its morphological appearance and aggressive behavior may have resulted in its being diagnosed as so-called giant cell malignant fibrous histiocytoma (MFH) in the past. Effusions are not uncommon in LMS and may be indicative of an unfavorable prognosis. We report a case with the cytological appearance of a uterine LMS with OGCs metastatic to lower pelvic peritoneum. The pelvic washing specimen consisted of three-dimensional aggregates of atypical cells. The cytohistologic and immunohistochemical study obtained from the cell block and the tumor mass showed overlapping features such as bizarre pleomorphic spindle cells containing numerous evenly dispersed OGCs. The malignant tumor cells showed extensive positivity for desmin, h-caldesmon and multifocal positivity for smooth muscle actin (SMA) whereas OGCs stained with CD68. We stress the usefulness of performing cell block and subsequent immunohistochemistry in order to make an accurate cytohistologic correlation.

Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis of mediastinal metastases of clear cell renal cell carcinoma

Evaluation of mediastinal lymphadenopathy in patients with a previous diagnosis of renal cell carcinoma (RCC) is critical for the determination of further treatment. A minimally invasive method of cytology sampling of mediastinal lymph nodes using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) has emerged as a useful tool in diagnosis. Between January 2010 and April 2018, we performed 1744 EBUS-TBNA studies of mediastinal and hilar lymph nodes for a variety of clinical indications including mediastinal malignancy. Sixteen patients (93.7% males, mean age 59.1 years, range 44–81 years) were diagnosed by cytological and cell block study to have metastatic clear cell RCC. Twelve patients had been diagnosed with clear cell RCC in the past (mean 39 months, range 4–89 months) while in four, the tumor was primarily diagnosed in the staging phase on the basis of EBUS-TBNA. The EBUS features of the mediastinal nodal masses included increase of size (mean 2.5 cm, range 1.6–3.8 cm), irregular, inhomogeneous, hypervascular, and hyperechoic echotexture. EBUS-TBNA is a procedure safe and effective for evaluating mediastinal lymphadenopathy in patients with clear cell RCC. Immunohistochemistry in the cell block is decisive for proper diagnosis. The cytologist plays a key role in the diagnosis of metastatic clear cell RCC due to the treatment implications that this neoplasm encompasses.

Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in the Diagnosis of Hilar and Mediastinal Lymph Node Metastases of Melanoma.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive technique for investigating hilar and mediastinal lymphadenopathy. This study reports eleven cases in which EBUS-TBNA was used to assess mediastinal and hilar lymph nodes for the presence of metastatic melanoma. A retrospective study was performed of all patients who had a history of melanoma and underwent EBUS-TBNA to assess hilar or mediastinal lymphadenopathy for the presence of metastatic melanoma. In seven cases, molecular analysis to detect mutations in the BRAF gene was also used. Eight patients had been diagnosed with malignant melanoma in the past (mean 54.4 months, range 18 to 115 months) while in the other three this tumor was primarily diagnosed in the staging phase. The male-female ratio was 6:5, and the mean age was 60.3 years (range 42 to 88 years). The mean hilar or mediastinal lymph node size detected with computed tomography was 3.0 cm (range 1.1 to 8.1 cm). Eight (72.7%) cases had metastases to the lung associated with metastases in the mediastinal lymph nodes. In four (50%) of these cases, the lung metastasis was solitary. Three (27.3%) cases had metastases in the mediastinal lymph nodes in absence of lung metastases. Metastatic melanoma was diagnosed by cytology and confirmed by cell block study with immunohistochemistry in all cases. BRAF mutations were detected in two (28.6%) of seven cases studied. Cytology and tissue samples obtained from EBUS-TBNA are adequate to detect metastatic melanoma and permit in some cases the determination of biomarkers and identify the presence or absence of mutations in the BRAF gene. The procedure is safe, fast, and precise for the staging of melanoma.

FNAC Versus CNB: Who Wins the Match in Breast Lesions?

The triple test lies at the heart of preoperative diagnosis of breast lesions. Raised awareness and self-assessment have significantly increased the rate of detection of breast pathologies. The managing clinicians usually decide the imaging and pathological modalities to the best interest of the patients. Core needle biopsy (CNB), cell-block studies, and fine needle aspiration cytology (FNAC) coupled with rapid on-site evaluation (ROSE) have significantly increased the accuracy of preoperative diagnosis. Immunocytochemistry, immunohistochemistry on cell blocks, and other ancillary studies give confidence to the clinicians to decide the best treatment strategies.

Fine Needle Aspiration Cytology and Cell Block Study of Various Breast Lumps

Fine Needle Aspiration Cytology and Cell Block Study of Various Breast Lumps