Cell Block Technique Research Articles

A Comparative Study of Sodium Alginate and Plasma Thrombin Cell Block in Diagnostic Cytopathology.

Background: Cell block is an indispensable supplement in the practice of cytopathology. The diagnostic utility of cytology specimens is significantly impacted by the capacity to generate sufficient cell blocks obtained from concentrated fluid samples or fine-needle aspiration specimens after routine processing. This routine processing involves getting directed passes to produce a cell block, especially if the cytopathologist believes additional immunocytochemical stains and/or molecular studies would be required. Objective: This study compared two methods of cell block preparation: the sodium alginate (SA) method and the plasma thrombin (PT) method. A comparison was made regarding overall cellularity, morphological preservation, and concealed artifacts. Methodology: This cross-sectional study evaluated 104 serous fluid samples and fine-needle aspirates. Cell blocks were prepared for each sample using the plasma thrombin and sodium alginate technique. The formalin-fixed, paraffin-embedded cell blocks were subjected to histochemical staining with hematoxylin and eosin, and slides were assessed for cellularity, artifacts, and morphological preservation. Results: The study utilized chi-square tests to analyze cellularity, morphology, and artifact presence, demonstrating significant differences in cellularity and artifacts between the two methods, with the sodium alginate method showing more cellularity and more artifacts, while morphologically, there was no significantdifference between the two methods. Conclusion: Our study's findings have practical implications for cytopathologists. We conclude that, compared to plasma thrombin methodology, the sodium alginate cell block technique yields higher cellularity, while there was no difference in morphology. Even though artifacts were more prevalent in sodium alginate cell blocks than in plasma thrombin cell blocks, our study suggests that the former can be a better alternative for cell block examination.

Cytomorphological comparison of alcohol-formalin cell-block technique with conventional cytology in serous effusions in a low-resource setting.

Our study compared the diagnostic accuracy of the 10% alcohol-formalin cell-block (CB) technique against traditional smears (CS) in serous effusions over 1 year. CB outperformed CS by detecting 7 missed cases and diagnosing 177 benign, 5 suspicious and 26 malignant cases compared to CS's 180 benign, 9 suspicious and 19 malignant cases. Using histopathology as a gold standard, CB showed a sensitivity of 96.4%, specificity of 98.3% and diagnostic accuracy of 98.1%, significantly higher than CS's 79.3% sensitivity, specificity of 97.7% and 95.2% accuracy. Using a 10% alcohol-formalin method, CB also excelled in cytomorphological characterization, especially in background elements, cellularity and cellular architecture. CB offered improved diagnostic accuracy and allowed extra sections for additional tests. In resource-constrained settings, combining CS and CB enhances cytological assessment.

The diagnostic utility of cell block as an adjunct to routine cytology

Despite the diagnostic utility of cell block in FNAC and fluid cytology, known for better cellular yield and improved diagnostic accuracy, the technique remains to be underutilized for diagnosing neoplastic lesions.In this paper, a hospital based prospective study of 195 samples was conducted on cytological samples with the aim (a) to evaluate the diagnostic utility of cell block as an adjunct to routine cytological evaluation of aspiration and effusion fluid specimens, (b) To correlate the findings of routine cytology, cell block and routine histopathological examination wherever possible and (c) to explore the possibility of using ancillary techniques such as immunohistochemistry on cell blocks. The study revealed, most of the patients were between 51- 60 years with female preponderance. Among 195 samples, 79 (40.5%) were peritoneal fluids and 85 (43.5%) were lymph node. The diagnosis on conventional smear and cell block showed 71 (36.5%) cases and 68 (35%) cases were negative for malignancy respectively. 6 (3%) cases and 4 (2%) cases were suspicious for malignancy respectively. 118 (60.5%) cases and 123 (63%) cases were positive for malignancy respectively. Amongst the peritoneal effusion the most common primary site was ovary whereas majority of the primary site was unknown in lymph node FNAC. Peritoneal effusion showed 8 additional cases as positive for malignancy in CB preparation which were negative or suspicious for malignancy on CS. In FNAC, two additional positive case was found in CB preparation of lymph node. A Kappa value of 89.5 % for statistical correlation between Conventional smear and cell block preparation was calculated. The use of Cell block technique increases the detection of malignancy when used as an adjunct to conventional smears. Cell block technique is simple, inexpensive and reliable adjuvant to smears and it is recommended for routine cytological diagnosis and for application of immunomarkers and molecular studies.

Deciphering Serous Effusions Using the New International System for Reporting Serous Fluid Cytopathology.

Introduction Serous effusion cytopathology is a minimally invasive, cost-effective procedure and plays a crucial role in diagnosing a spectrum of pathological conditions, rangingfrom benign to malignant. The International System for Reporting Serous Fluid Cytopathology (ISRSFC) offers a standardized framework for reporting serous effusions, aiding in better communication and clinical decision-making. Aims and objectives This study aimed to categorize effusions using the ISRSFC reporting system. In addition, we sought to estimate the risk of malignancy (ROM) for each diagnostic category and evaluate the diagnostic performance of conventional smear versus cell block techniques. Materials and methods Thiscross-sectional study was conducted in the Department of Pathology over one year. We applied the ISRSFC criteria to serous effusions and categorized them accordingly. The ROM for each category was assessed with histopathology serving as the gold standard. Then, the diagnostic performanceincluding sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy was evaluated using conventional smear and cell block techniques. Results The study included185 serous effusion cases, with ages ranging from two months to 85 years. The male-to-female ratio was 1.1:1. Most effusions were pleural fluids constituting about 133 cases (71.9%), followed by peritoneal fluids (47 cases, 25.4%)and pericardial fluids (five cases, 2.7%). Among the fluids, four (2.2%) were diagnosed as non-diagnostic (ND), 152 (82.2%) as negative for malignancy (NFM), four (2.2%) as atypia of undetermined significance (AUS), nine (4.8%) as suspicious for malignancy (SFM), and 16 (8.6%) as malignant (MAL).The overall ROM was 25% for ND, 8.5% for NFM, 50% for AUS, 77% for SFM, and 100% for MAL. The sensitivity, negative predictive value (NPV), and diagnostic accuracy were superior when combining conventional smear with the cell block technique. Conclusions Our findings underscore the use of ISRSFC in categorizing effusion samples, assessing the ROM, and guiding clinical management. Moreover, our study highlights the benefits of employing a combined approach using conventional smears and cell blocks for enhanced diagnostic accuracy in serous effusions.

Diagnosis of Body Fluids Using a Combined Approach of Cytomorphology in Routinely Stained Smears and Cell Blocks: A Boon for Primary Health Care in this Era of Molecular Medicine!

Accurate diagnosis of cells as reactive or malignant mesothelial cells in body fluids is a common problem. The limited sensitivity of cytodiagnosis in effusions primarily results from unclear morphological details of cells, cell overcrowding or overlapping, cell loss, and changes caused by diverse laboratory processing techniques. Numerous studies have observed that despite meticulous preparation, cytological assessments of fluid through smears often leave substantial unexplored residue, potentially harboring valuable diagnostic information. The unexplored residue can be easily and pragmatically assessed using the cell block method, where it is embedded in paraffin and examined alongside routine smears. Cell blocks prove especially beneficial when conventional cytological smear methods fall short in providing accurate diagnoses, as seen in cases such as reactive mesothelial cells, or when findings are ambiguous, as in occasional well-differentiated adenocarcinoma. The present study reviews the usefulness and benefits of cell block method in cyto-diagnosis of body fluids and highlight the importance of ancillary techniques such as immunohistochemistry (IHC) in improving the sensitivity of diagnosis. It was observed that isolated use of conventional smear misses the diagnosis when there is cell overcrowding, low cellularity, and deranged morphology. Hence, with the application of a simple cell block technique with or without ancillary techniques such as IHC, we can provide a quality report for better patient outcome even at the level of primary health care.

Utility of guided FNAC and cell block preparation from liver and gall bladder masses: Learning experience from a tertiary care center.

Ultrasound- and CT-guided fine needle aspiration cytology (FNAC) increases the accessibility of intra-abdominal masses to the liver and gall bladder with the advantages of low cost and high diagnostic yield. Cell block technique has been known for further increasing the diagnostic accuracy. We aimed to study the effectiveness of FNAC and the cell block method in cytological diagnosis of liver and gall bladder masses. We also followed a step-wise approach to increase the success rate. A 2-year observational study was done from July 2020 to June 2022. Total 80 guided (CT and ultrasound) aspirations were done from space occupying/mass lesions in the liver [74 (92.5%)] and gall bladder [6 (7.5%)], out of which cell blocks by the plasma thrombin method were prepared in 12 cases (15%). The on-site radiological details were noted, and rapid on-site evaluation was done in 65 cases (81.25%). The prepared cytology slides were stained with Papanicolaou, H and E and May-Grunwald Giemsa (MGG) stain. The cytological diagnosis was noted, and the uses and limitations (if any) were observed in each case. A step-wise structured questionnaire format was developed to assist the reporting pathologist so as not to miss out on important diagnostic observations, if present. FNAC in 71 cases (88.7%) gave a conclusive diagnosis. The maximum number of cases were of adenocarcinoma [38 (51.3%)] from the liver followed by hepatocellular carcinoma in 10 cases (13.5%). In gall bladder masses, all 6 cases (100%) were positive for malignancy, out of which 4 cases (66.7%) could be characterized as adenocarcinoma. The cell block preparation was helpful in reaching the diagnosis as well as typing the malignancy in 10 cases (83.3%). The chief limitation observed on conventional cytology smears was inadequate cellularity, which caused inconclusive diagnosis in 9 cases (11.25%). The reporting questionnaire was helpful chiefly in terms of time-efficient reporting in 34 cases (42.5%), increasing the ease and confidence in 69 cases (86.25%) and the advantage of reproducibility of data in all cases (100%) according to the case-by-case evaluation by the reporting pathologists. Guided FNAC in conjunction with the cell block technique is extremely helpful in the evaluation of mass lesions of the liver and gall bladder for cytological diagnosis. A proper step-wise approach may be useful to reach a quick and effective diagnosis.

Multiple myeloma in dogs: Use of the cell block technique as a new diagnostic tool.

The diagnosis of multiple myeloma (MM) in dogs may be challenging and complex. The cell blocks are a diagnostic technique that allows the characterization of neoplastic cells and, therefore, might help in the diagnosis of atypical MM. The objective of the present work is to describe three clinical cases in which the cell blocks and immunohistochemistry contributed to the definitive diagnosis of canine MM. Three dogs, one female and two males, with different clinical signs, were presented for consultation with anemia, hyperproteinemia with monoclonal gammopathy, and the presence of plasmacytosis in the bone marrow. Cytologic analysis of the spleen was performed in two dogs and was suggestive of the presence of lymphocytes or plasma cells of a neoplastic nature in one of the cases and plasma cell hyperplasia associated with extramedullary hematopoiesis in the other. Given the hypotheses of lymphoid neoplasms with a plasma cell phenotype, cell blocks from aspiration punctures were performed for immunohistochemical analysis with anti-CD3, CD20, CD79αcy, PAX5, and MUM1 antibodies. The results revealed positive staining for MUM1 in 80% of the cells in the spleen cell block and for CD20 and MUM1 in 70% of the cells in the bone marrow cell blocks, with negative staining for the other antibodies. The immunophenotyping results allowed the diagnosis of MM in the three cases and excluded other lymphoid neoplasms. This work reinforces the importance of using cell blocks in the diagnosis of neoplasms by demonstrating their potential to aid the diagnosis of MM.

Diagnostic Utility of Cell block and Immunocytochemistry in Differentiating Malignant from Non-malignant Effusions: A Cross-sectional Study

Introduction: Cytological evaluation of body cavity fluids has been widely employed in diagnosing the underlying aetiology. Differentiating reactive mesothelial cell proliferations from metastatic malignant cells based on cytomorphology alone is challenging. Therefore, the use of cell blocks in conjunction with immunocytochemistry can significantly improve diagnostic accuracy. Aim: To investigate the role of cell blocks and immunocytochemistry in distinguishing malignant from non- malignant effusion fluids. Materials and Methods: A prospective cross-sectional study was conducted on 70 serous effusion fluid samples (ascitic and pleural fluids) received in the Cytology section of the Pathology Department from October 2021 to November 2022. Relevant clinical details, including demographic information, age, gender, presenting complaints, and radiological and laboratory investigations, were documented from the patients’ medical records. All fluids underwent conventional cytology, and the remaining fluid was used for cell block preparations. Immunocytochemistry was performed using Ber-EP4 and Calretinin immuno-markers to differentiate between reactive mesothelial cells and malignant cells. The association between cytosmear/cell block and immunocytochemistry was calculated using the chi-square test. Results: Out of the 70 cases, 44 were pleural fluids, and 26 were ascitic fluids. Conventional cytology identified 11 positive cases, 20 suspicious cases, and 39 negative cases for malignancy. However, after cell block examination, the total number of positive cases reduced to 9, suspicious cases decreased to 12, and negative cases increased to 49, resulting in a 14.3% increase in diagnostic accuracy. Immunocytochemistry using Ber-EP4 showed strong positivity in 12 cases, indicating epithelial malignancy (adenocarcinoma), while 9 cases were Ber-EP4 negative. Calretinin positivity was observed in the mesothelial cells of all 21 cases where immunohistochemistry was performed, resulting in a 17.5% increase in diagnostic accuracy. Conclusion: The combination of cell block technique with conventional cytology improves the diagnostic yield and accuracy by providing better interpretation of architectural patterns and cytomorphology. Additionally, the application of immunocytochemistry using Ber-EP4 and Calretinin aids in distinguishing malignant from non-malignant serous effusions.

Detection of Circulating Tumor Cells by Cell Block Technique in Malignant Tumors.

Cancer is a leading cause of death worldwide and is a major cause of morbidity. To deal with this magnitude of cancers and their diagnostic and prognostics, a multitude of prognostic biomarkers for various cancers have been explored over the decades, with detection of circulating tumor cells (CTCs) in the peripheral blood being one of them. This study was undertaken to explore the routine procedure of cell block in the cytopathology lab to isolate and detect CTCs. In this cross-sectional study, 112 peripheral blood samples sent for routine blood investigations of various cancer patients were utilized for the preparation of cell block. The sections from the cell block were stained routinely and evaluated for the presence of CTCs. The statistical analysis was done using Mac Statplus software version 8.0. The malignancies were tabulated as per the International Classification of Diseases for Oncology, third edition (ICD-O-3). The maximum number of cases were from C 50 (breast) - 41/112 (36.6%), followed by C15-C26 (Digestive organs) - 19/112 (16.9%), and C00-C14 (lip, oral cavity, and pharynx) - 18/112 (16.07%) cases. CTC was detected in six (5.35%) out of 112 cases, out of which three were from the breast and one each from category C6.9 (mouth), C32.0 (glottis), and C53.8 (cervix uteri). Among various advanced and molecular techniques available for the detection of CTCs, the cell block technique proves to be one of the effective methods, especially in resource-limited settings as these can further be utilized for additional diagnostic techniques similar to the ones employed for routine paraffin blocks.

Immunocytochemistry on frozen-embedded cell block for the diagnosis of hematolymphoid cytology specimen: a straightforward alternative to the conventional cell block.

Agarose-based cell block (CB) technique can be modified to be combined with the frozen section technique for the preparation of a high-quality frozen-embedded CB (F-CB) from an effusion or fine-needle aspiration (FNA) cytology sample. This combined technique can be effectively used for the immunocharacterization of the hematolymphoid cells on F-CB. To demonstrate the applicability of performing diagnostic ICC on F-CB, we have analyzed the immunophenotype of the hematolymphoid cells in a series of eight cases of effusions and eight cases of FNA cytology specimens by using CB-ICC on sections cut from frozen-embedded CBs. The SurePathTM residue or cytologic material scraped off from the FNA cytology smear that was diagnostic for or suspicious of hematolymphoid malignancy was pelleted and pre-embedded in agarose. Half of the agarose-embedded pellet was frozen-embedded in OCT compound for the preparation of F-CB, while the other half was processed for the preparation of paraffin-embedded CB. Sections cut from the F-CB and P-CB were used for CB-ICC. Panels of ICC on the F-CBs could enable the immunocytochemical differential diagnosis of large cell hematologic malignancies that encompass anaplastic large cell lymphoma and other forms of large-cell hematolymphoid malignancies such as large B-cell lymphomas, anaplastic plasma cell myeloma, myeloid sarcoma, and T-lymphoblastic lymphoma. It also appeared that the small B-cell lymphomas in the effusions or FNAs could be differentially diagnosed with the aid of CB-ICC on the F-CB. A modified agarose-based CB technique can be combined with the frozen-embedded CB method for the preparation of F-CB that can be directly used for the immunocytochemical differential diagnosis of hematolymphoid cytology samples.

Study on the application of percutaneous closed pleural brushing combined with cell block technique in the diagnosis of malignant pleural effusion.

This study was to investigate the diagnostic value of percutaneous closed pleural brushing (CPBR) followed by cell block technique for malignant pleural effusion (MPE) and the predictive efficacy of pleural fluid carcinoembryonic antigen (CEA) for epidermal growth factor receptor (EGFR) mutations in lung adenocarcinoma patients with MPE. All patients underwent closed pleural biopsy (CPB) and CPBR followed by cell block examination. MPE-positive diagnostic rates between the two methods were compared. Univariate and multivariate analyses were performed to determine factors influencing the EGFR mutations. Receiver operating characteristic (ROC) curve was used to analyze the predictive efficacy of pleural fluid CEA for EGFR mutations. The cumulative positive diagnostic rates for MPE after single and twice CPBR followed by cell block examination were 80.5% and 89.0%, higher than CPB (45.7%, 54.3%) (P < 0.001). Univariate analysis showed that EGFR mutation was associated with pleural fluid and serum CEA (P < 0.05). Multivariate analysis showed that pleural fluid CEA was an independent risk factor for predicting EGFR mutation (P < 0.001). The area under the curve (AUC) of pleural fluid CEA for EGFR mutation prediction was 0.774, higher than serum CEA (P = 0.043), but no difference with the combined test (P > 0.05). Compared with CPB, CPBR followed by the cell block technique can significantly increase the positive diagnostic rate of suspected MPE. CEA testing of pleural fluid after CPBR has a high predictive efficacy for EGFR mutation in lung adenocarcinoma patients with MPE, implying pleural fluid extracted for cell block after CPBR may be an ideal specimen for genetic testing.

USE OF CYTOLOGICAL SMEAR AND CELL BLOCK TECHNIQUE FOR THE DIAGNOSIS OF PLASMA CELL MYELOMA INFILTRATION IN THE MANDIBLE

Fine-needle aspiration cytology (FNAC) is a diagnostic tool using a needle to collect samples for cytopathological examination. We report a case of a 49-year-old male patient with previous medical history of plasma cell myeloma (PCM), who had osteolytic lesions in the mandible, diagnosed by FNAC. Imaging exams exhibited multiple osteolytic lesions with ill-defined margins in the bilateral mandibular body. FNAC of the intraosseous lesion of the mandible was performed. Cytological smear and cell block technique revealed plasma cells in different degrees of maturation, predominantly eccentric pleomorphic nuclei and abundant, eosinophilic cytoplasm without a paranuclear halo. Immunohistochemistry exhibited positivity for CD138, lambda light chain and Ki-67 (proliferation index was ∼50%). Based on clinicoradiographic, microscopic, and biochemical findings, the diagnosis was PCM infiltration in the mandible. The patient underwent chemotherapy and autologous hematopoietic stem cell transplantation, and had partial remission after 10 months of follow-up. Fine-needle aspiration cytology (FNAC) is a diagnostic tool using a needle to collect samples for cytopathological examination. We report a case of a 49-year-old male patient with previous medical history of plasma cell myeloma (PCM), who had osteolytic lesions in the mandible, diagnosed by FNAC. Imaging exams exhibited multiple osteolytic lesions with ill-defined margins in the bilateral mandibular body. FNAC of the intraosseous lesion of the mandible was performed. Cytological smear and cell block technique revealed plasma cells in different degrees of maturation, predominantly eccentric pleomorphic nuclei and abundant, eosinophilic cytoplasm without a paranuclear halo. Immunohistochemistry exhibited positivity for CD138, lambda light chain and Ki-67 (proliferation index was ∼50%). Based on clinicoradiographic, microscopic, and biochemical findings, the diagnosis was PCM infiltration in the mandible. The patient underwent chemotherapy and autologous hematopoietic stem cell transplantation, and had partial remission after 10 months of follow-up.

Diagnostic efficacy of conventional cytological smears and cell block of ascitic fluid for detection of malignant cell

Introduction: For identification of malignant cells in effusion, cell block is a simple, inexpensive method and no additional expatriation is needed. In the identification of malignant cells in effusion, its differentiation from cells showing reactive and degenerative changes were diagnostic difficulties in some of the cases. The cell block method yielded more cellularity and provided better morphological details. Multiple sections could be obtained for special stain and immunohistochemistry when required. Methods: This cross-sectional observational study was carried out at the Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; from March, 2017 to December, 2018. The sample size was 101 and the study material was ascitic fluids of clinically suspected malignancy cases. Conventional smears and cell block were prepared in every cases. Both conventional and cell block slides were scored according to Miar’s point scoring system and analyzed according to diagnostic categories. Results: By conventional smear, 86 cases were diagnosed as negative for malignancy, four cases were diagnosed as suspicious for malignancy and remaining 11 cases were diagnosed as positive for malignancy. After analyzing cell blocks, three more malignant cases were diagnosed, which had been diagnosed as suspicious for malignancy by conventional smear. Cell block technique showed significant differences in the diagnosis of suspicious cases of effusion in comparison to conventional smear (p&lt;0.05) Conclusion: Cell Block technique could be considered as a useful adjunct in evaluating malignant cells in malignant ascitic effusion for a final cytodiagnosis, along with the routine conventional method. Mediscope 2023;10(1): 01-09

ANALYSIS OF CELL BLOCK VERSUS CONVENTIONAL SMEAR STUDY IN FLUID CYTOLOGY

Background: The cytological examination of body uids is routinely accepted, simple and minimally invasive technique. Cell block preparation along with conventional smear increases sensitivity of detecting malignancies by preservation of tissue architecture and obtaining multiple sections for special stain and immunohistochemistry. To assess and compa Objectives: re the diagnostic yield of conventional smear (CS) and cell block (CB) techniques in uid cytology. A total of 62 body uid specimen were simult Materials And Methods: aneously processed and examined by conventional smear and cell block technique. The morphological details, cellularity, architecture, nuclear and cytoplasmic details were studied in both CS and CB techniques. Out of 62 uid samples a total of 47 smears and 58 c Results: ell blocks had adequate material. On smears a total of 11 cases were malignant, 3 were suspicious and 33 were benign. On cell block a total of 15 cases were malignant, none was suspicious and 43 were benign. CB technique is superior to CS technique as it plays a signicant role Conclusion: in resolving the gray zone while determining the nature of cells on effusion whether reactive, atypical or malignant. Also it provides diagnostic advantage by making residual material available for special stains and IHC

Cytological, cell block and immunohistochemical analysis of spectrum of malignant pleural effusion with special reference to non-small cell lung carcinoma: A hospital based study of North East India

Malignant pleural effusions (MPE) can result from primary malignancies of the pleura or from underlying intrathoracic or extrathoracic malignancies that reach the pleural space by hematogenous, lymphatic, or contiguous spread. Conventional smear and cell block (CB) technique is one of the oldest methods for the evaluation of body cavity fluids. The principal advantage of cell block over conventional smears are an additional yield of malignant cells and obtaining multiple sections for ancillary tests such as immunohistochemistry (IHC). This study is a hospital-based cross-sectional study which was conducted for a period of 14 months from June 2021 to July 2022 in a tertiary care centre of North East India. Among 277 pleural effusion specimens 11.91% cases were positive for malignancy.Lung carcinoma was the most common cause of malignant pleural effusion. Non-small cell lung carcinoma comprised majority of lung carcinoma cases. Adenocarcinoma was the most common subtype of NSCLC with female preponderance. Cytological diagnosis had a Sensitivity of 76.19%, specificity of 100% andAccuracy of 96.5%. Immunohistochemistry of lung carcinoma in cell block preparation revealed 77.77% cases of adenocarcinoma of lung were positive for TTF-1(P&amp;#60;0.018). Immuno-expression of P63 and P40 showed positive expression in both the cases of squamous cell carcinoma. Conventional smear and cell block method with application of immunohistochemistry will help us in accurate diagnosis of primary site of the tumour aiding early treatment especially in resources restricted hospitals.

Endometrial Secrets Unmasked through Cytology Analysis.

Endometrial aspiration (EA) is an economic, painless technique on an outpatient basis. Present study aimed at cytological evaluation of EA for (a) cellular yield and morphology and (b) utility of cell block (CB) and cytocentrifuge (CC) techniques. EA samples were divided into two aliquots. Colorless samples were processed (1000 rpm × 6 min) for conventional smear (CS) and CC, both stained by Papanicolaou. Hemorrhagic samples were processed for CS and CB (paraffin embedding, hematoxylin-eosin stain). Endometrial aspirates from January 2021 to January 2022 were included. Indications comprised abnormal uterine bleeding (AUB; 87), prolapse (eight), and infertility (two). Among 77 hemorrhagic aspirates, the yield was 85.7% by CS and 90.9% by CB. Among 20 colorless aspirates, the yield was 55% by CS and 65% by CC. The yield was 85.7%, 84.4%, and 83.3% with endometrial thickness 1-5, 6-10, and 11-15 mm, respectively. The yield was 83.9%, 50%, and 0% in AUB, prolapse, and infertility, respectively. CS morphology showed the categories of benign (93.5%) and atypia (6.5%). All cases with benign morphology correlated with CB and CC. CB offered architectural evaluation, while CC had a shorter turnaround time. Focusing on menorrhagia cases in secretory phase, nondilution of EA samples, and simultaneous endometrial biopsy can enhance cytology evaluation. In an era where "less should convey more," EA shows potential as a screening technique vis-à-vis invasive "dilatation-curettage" technique.

A comparative study of conventional cytology and cell block in the diagnosis of pleural effusion with special reference to immunohistochemistry

Background: Body cavity fluids are evaluated by cell block (CB) technique. In conventional cytological smears (CS), appropriate identification of the cells as either reactive mesothelial cells or malignant cells is a diagnostic problem. In CB method, there is increase in cellularity, so it gives more morphological details of cells and improving the sensitivity of diagnosis. Sections obtained by CB method are also can be stored for future study like immunohistochemistry (IHC). Aims and Objectives: The aim of the study was to determine the diagnostic efficacy of CB technique over conventional CS and to study of IHC in CB of malignant pleural effusion. Materials and Methods: This will be institution-based, cross-sectional, and observational study. The pleural fluid (except blood and pus) obtained by thoracocentesis from both male and female patient (&gt;18 years of age) 100 cases was included in the study. Pleural fluid mixed with blood/pus, fluid from cystic lesion, and inadequate sample (&lt;15 ml vol.) were excluded in the study. Results: Association between architectural pattern in CB versus architectural pattern in cytology smear showed statistically significant value Chi-square: 201.7417, P &lt; 0.0001. Conclusion: We may conclude that CB technique is better than conventional cytology smear technique especially in case of malignant pleural effusion. It increases true positive cases and decreases false negative cases. It also increases cellularity, maintain architectural pattern, and cellular morphology.

Cell Block versus Cytospin in the Detection of Malignancy in Body Fluids: A Cross-sectional Study

Introduction: Cytological examination of body fluids is a commonly performed investigation that provides information about inflammatory and malignant lesions, aiding in the diagnosis of effusion aetiology and potential differential diagnoses. The cell block technique, combined with cytospin study, offers an additional advantage in such cases. Aim: To compare the diagnostic utility of cell block method and cytospin method in detecting malignancy in body fluids. Materials and Methods: This cross-sectional observational study was conducted for a period of two years at Bharati Vidyapeeth (DTU) Medical College Hospital and Research Centre in Pune, Maharashtra, India. A total of 100 body fluid samples were analysed, including 73 pleural fluids, 24 ascitic fluids, and 3 pericardial fluids. Each fluid sample was divided into two equal parts: one processed for cytospin (CYTOTEK), and the other processed to create a cell block. Four Immunohistochemistry (IHC) markers (Thyroid Transcription Factor-1 (TTF-1), Cytokeratin 7 (CK7), Cytokeratin 20 (CK20), and Calretinin) were applied as needed. Data analysis was performed using the Statistical Package for Social Sciences (SPSS) version 25.0, and results were calculated using the Chi-square test. Results: Of the total 100 fluid samples, 65 were negative, 17 were positive, and 18 were suspicious for malignancy using the cytospin method. In comparison, the cell block method identified 63 samples as negative, 29 as positive, and 8 as suspicious for malignancy. The cell block method exhibited a higher sensitivity (100.00%) and specificity (94.03%) than the cytospin method (81.82% and 88.06%, respectively) in this study. Conclusion: Cell block method accurately diagnosed 10 cases as positive for malignancy that were initially deemed suspicious on cytospin smear. Therefore, the cell block method proved to be a superior diagnostic tool for malignancy compared to cytospin smear. Given that cell blocks allow for longer storage and additional analysis such as IHC and microarray, they should be adopted in addition to cytospin for effusion cytology

Comparing Conventional Cytology Smear and Cell Block Techniques for Ovarian Cancer Diagnosis: A Prospective Observational Study

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&amp;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.

Heat Induced Processing of Cellblocks with Significant Reduction in Overall Turn Around Time.

Cellblock (CB) with immunohistochemistry (IHC) is practically indispensable in the diagnostic workup of serous effusions; however, CB requires a minimum of 15-20 h for routine histopathological processing. A reduction in processing time can expedite a faster diagnosis. This study was undertaken to evaluate the utility of the heat-induced CB (HICB) technique. Two sets of agar-embedded CBs were processed from 50 effusion samples. CBs were further processed by conventional and rapid methods. Conventional CBs (CCB) were processed in a histoprocessor, whereas rapid CB was processed in a heated water bath with an agitation facility. For HICB processing, dehydration and clearing were performed at 50°C followed by paraffin wax impregnation at 65°C temperature. From both CBs, sections of 5 um thickness were cut and stained with hematoxylin and eosin (H and E). Cell morphology, cost, and time were compared between the two methods. The feasibility of IHC was attempted in a few cases. HICB was completed within 4.30 h compared with CCB. Diagnoses on both CBs were concordant in all the cases. Incomplete dehydration was noted in six (12%) cases, but the diagnosis was not compromised. No additional cost was involved in HICB. On IHC, both HICB and CCB exhibited equivalent expression. HICB is a rapid, innovative, simple, and cost-effective technique and expedites faster diagnosis. It does not require any advanced equipment.