Cell Block Technique Research Articles

A comparison of two techniques of cell block preparation

Background: Cell block technique is a method of preparing cytological material so that it can be processed, sectioned, stained, and viewed as a histology section. The study compared two methods of cell block preparation, plasma-thromboplastin method and collodion bag technique of cell block preparation.
 Materials and Methods: Samples were randomly processed by plasma-thromboplastin technique or by collodion bag technique. Hematoxylin/Eosin stained cell block sections were examined and scored scaling from 1 to 3 for cellularity, clarity, nuclear features, cytoplasm, use of ancillary test and recovery of cell-cluster and fragments. Mann-Whitney U test was used for comparing two methods and establishing statistical significance.
 Results: The median cellularity score was 2.0 for plasma-thromboplastin and 1.0 for collodion bag. The median morphological preservation score and use of ancillary test score were 2.0 for both of the method while median score for recovery of cell cluster and fragments was 2.0 for collodion bag and 1.0 for plasma-thromboplastin. Statistically, both of the methods had similar results in cell block quality.
 The median total score for plasma-thromboplastin and collodion bag were 10.0 and 11.0 respectively. Diagnostic cell blocks were obtained in 46.51% of cell block by plasma-thromboplastin method and 60.52% of cell block by collodion bag method improving the diagnosis over conventional smear in 76.74% and 81.57% respectively.
 Conclusions: Cell block by plasma-thromboplastin and collodion bag method are cost effective, useful adjunct to FNA for diagnosis of mass lesion. Both techniques has no significant difference in quality of cell block produced.

Risk factors for failure of vitrectomy cell block technique in cytological diagnosis of vitreoretinal lymphoma.

To determine the factors that may affect the accuracy of vitrectomy cell block technique in detecting atypical lymphoid cells in patients with vitreoretinal lymphoma (VRL). We retrospectively reviewed 43 eyes in 39 patients who underwent vitrectomy for definitive histological diagnosis of VRL with vitrectomy cell block technique and/or smear preparation at Kyushu University Hospital from January 2001 to March 2016. The association of detection of atypical lymphoid cells using vitrectomy cell block technique with the following factors was assessed using logistic regression analysis: age at diagnosis, sex, presence or absence of concurrent cataract surgery with vitrectomy, clinical grading of vitreous haze, presence or absence of subretinal tumor infiltration, interval between initial symptoms and vitrectomy, and presence or absence of systemic corticosteroid therapy before vitrectomy. Atypical lymphoid cells were more significantly detected using vitrectomy cell block technique compared to that using smear preparation (p = 0.018). After adjusting for age and sex, concurrent cataract surgery (odds ratio [OR], 10.41; 95% confidence interval [CI], 1.42-76.41) and subretinal tumor infiltration (OR, 5.06; 95% CI, 1.06-24.32) were significantly associated with failure of histological analysis with vitrectomy cell blocks. In multivariable logistic regression analysis, similar results were obtained, although subretinal tumor infiltration was only marginally associated with the detective capability of the technique. Vitrectomy cell block technique significantly improved the definitive diagnosis of VRL. Concurrent cataract surgery with vitrectomy and subretinal tumor infiltration were risk factors for failure in vitrectomy cell blocks.

The Diagnostic Utility of Cell Block Preparation with Conventional Cytological SmearsA Cross Sectional Study

Background: Cytological examination of serous fluids aspirated is a simple and relatively non-invasive technique to diagnose whether the effusion is malignant or benign. Cell block preparation along with conventional smear increases the sensitivity of detecting malignancies, and also has the ability to reduce false-positive interpretations. Methods: A total 68 samples of body fluid (pleural and ascitic) specimens were examined for conventional cytological smear (CS) and cell block method (CB) over a period of one year. Out of 68 fluids, 40 were pleural fluid and 28 were ascitic fluid. Each fluid specimen was examined by conventional smear technique as well as cell block technique. The morphological details, cellularity, architecture, nuclear and cytoplasmic details were studied in both CS and CB techniques. Result: A total 82.35% smears had adequate material; while of the total cell blocks, 75% cell blocks had adequate material. A total of 11.76% cases were malignant on smears,5.88% were suspicious of malignancy, 64.7% were benign/non-neoplastic lesions. A total 13.2% cases were malignant on cell block, 1.47% were suspicious of malignancy, 60.29% were benign/non-neoplastic lesions. Sensitivity, positive and negative predictive value and accuracy of cell block technique were greater than that of FNAC smears Conclusion: For the final cytodiagnosis of body fluid, there is statistically significant difference between the two techniques. Cell blocks prepared from the residual fluid specimen can be useful for more definitive diagnosis, with advantage of IHC and special stains where required.

Analyzing diagnostic utility of cytospin and cell block techniques in serous effusion cytology

Introduction: Fluid cytology plays a pivotal role delineating benign from malignant effusions, tumor staging and diagnosing recurrences. Objectives: To assess the diagnostic utility of cytospin and cell block methods in cytodiagnosis of serous effusions.Material and methods: A total of 240 cases inclusive of 77 pleural and 163 peritoneal effusions were analyzed by cytospin and cell block preparation following conventional smear cytology.Results: Out of 240 cases, 13% were malignant pleural effusion and 14.7% were malignant peritoneal effusion. Cell block diagnosed additional 4% and 2.4% cases of malignant origin in pleural and peritoneal fluid respectively and also aided in ascertain the primary site. Few rare cases such as effusion in synovial sarcoma and squamous cell carcinoma were also diagnosed. Conclusion: Cell block technique aids in cytodiagnosis of malignant effusions but has demerits also, hence both cytospin and cell block should be used as complement.

Role of cell block technique as a novel diagnostic approach in odontogenic cysts and ameloblastomas of the jaw region.

Background:Fine-needle aspiration cytology (FNAC) involves puncturing a lesion for microscopic analysis. Smears are prepared using aspirated material for cytology and for cell block (CB) preparation. FNAC is a preoperative technique and does not provide sufficient information for precise diagnosis, and the risk of false diagnosis or intermittent diagnosis always exists. To overcome the deficiencies of FNAC, the CB technique (CBT) is considered a novel innovative technique for odontogenic lesions. The present study is carried out to evaluate the efficacy of CBT in diagnosing odontogenic cystic lesions and ameloblastoma of the jaw and comparing it with aspiration cytology and histopathology.Methods:In this prospective study, 17 patients with clinical diagnosis of odontogenic cysts and ameloblastoma are obtained. FNAC smears and CBs are prepared and compared with cytology and histopathology.Results:A total of 17 cases of odontogenic cysts and ameloblastoma are divided into seven odontogenic keratocyst (OKC), three dentigerous cysts, three radicular cysts and four ameloblastoma. In seven cases of OKC, five cases (71.4%) are showing positive features and two cases (28.6%) are showing negative features. Three dentigerous and three radicular cysts are showing three positive CB features (66.7%) and three negative features (33.3%). Among four cases of ameloblastoma, two cases (50%) are showing positive CB features and two cases (50%) are showing negative features.Conclusion:CB is a novel diagnostic technique in oral pathology for odontogenic cysts, tumors, metastatic tumors and bony lesions. Compared to FNAC, it gives accurate diagnostic architecture and apparent histopathological features. This technique can be used alternative to FNAC.

Morphological characterization and molecular profiling of malignant pericardial effusion in patients with pulmonary adenocarcinoma.

Malignant pericardial effusions (MPCEs) is a common complication observed in advanced pulmonary adenocarcinoma. In such cases, investigating molecular alterations can have significant therapeutic implication in determining anticancer drugs. The objective was to evaluate the significance of cell block technique in the diagnosis of MPCE and further investigate the morphological and molecular profiles of MPCE in patients with pulmonary adenocarcinoma. Cytopathological and molecular profiles of 19 MPCE cases in patients with pulmonary adenocarcinoma were retrospectively analyzed. The control group consisted of 14 malignant pleural effusion (MPE) cases in patients with pulmonary adenocarcinoma. Anaplastic lymphoma kinase (ALK) and tyrosine-protein kinase Met (C-MET) expression was evaluated by fluorescence in situ hybridization (FISH). Epithelial growth factor receptor (EGFR) and K-Ras (KRAS) mutations were detected by ARMS real-time polymerase chain reaction (RT-PCR). Associations between MPCE and MPE were analyzed using Fisher's exact test. MPCE was found to have micropapillary and solid pattern predominant with mucin secretion compared to acinar patterns, as seen in MPE. Seventeen MPCE cases (89.5%) and all MPE cases (100%) underwent molecular analysis. Mutations in EGFR and KRAS, ALK rearrangement, and C-MET amplification were observed in MPCE and MPE with statistical differences. Additionally, two MPCE cases demonstrated EGFR T790M mutation and multiple insertions at L858. MPCE shows micropapillary and solid cytological patterns predominant with mucin secretion. MPCE are suitable to analyze oncogenic mutations and to develop targeted therapy for patients with pulmonary adenocarcinoma. Further molecular investigations may reveal novel molecular alterations.

Diagnostic Efficacy of Cell Block Technique as a Complementary Adjunct to Fine Needle Aspiration Cytology

Diagnostic Efficacy of Cell Block Technique as a Complementary Adjunct to Fine Needle Aspiration Cytology

Differential diagnosis of mesenchymal neoplasms of the digestive tract by cell block and immunohistochemistry.

To evaluate the diagnostic yield of the cell block (CB) technique with immunohistochemistry in patients with mesenchymal neoplasms of the gastrointestinal tract collected by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA). Tissue samples from consecutive patients with subepithelial lesions collected by EUS-FNA, without analysis by on-site cytopathology, were evaluated by the same pathologist only using CBs in AAF fixative. Sections were stained with haematoxylin-eosin and underwent complementary immunohistochemical staining for SMA, CD117, DOG-1 and S100 in the presence of mesenchymal neoplasms. Specimens were defined as diagnostic when sufficient tissue was present for histopathological evaluation and immunohistochemistry analysis. If they were insufficient for complete evaluation, the specimens were considered nondiagnostic. Between September 2012 and December 2016, a total of 158 patients (median age: 57years, 64.5% women) underwent EUS-FNA with an average of three needle passes for every lesion. The median lesion size was 17mm. There were 113 mesenchymal neoplasms confirmed by immunohistochemistry (66 leiomyomas, 44 GISTs, two schwannomas, one leiomyosarcoma). The overall diagnostic yield of CBs was 84.17%. However, diagnosis was obtained in 98.5% (133/135) of the cases after exclusion of 23 cases in which EUS-FNA sampling was insufficient or without tumoural tissue. Only two mesenchymal neoplasms were not confirmed by CBs even after immunohistochemistry. CBs collected by EUS-FNA and analysed by immunohistochemistry showed a high diagnostic yield in patients with mesenchymal neoplasms, even without on-site cytopathology.

Evaluation of Cell Block Techniques in the Cytodiagnosis of Body Fluids in Meenakshi Medical College and Research Institute, Kanchipuram

Evaluation of Cell Block Techniques in the Cytodiagnosis of Body Fluids in Meenakshi Medical College and Research Institute, Kanchipuram

Evaluation of tissue trauma and healing on the basis of tumour necrosis factor-alpha, interleukin-6, and C-reactive protein in peripheral blood during and after pyometra in bitches

In this study, inflammation in the blood of bitches with pyometra (PG) was compared before and 15 days after ovariohysterectomy (OVH). The results were compared with those for control dioestrus bitches (CG) to reveal the evidence of inflammation in blood after a routine surgery. Inflammation was tracked by tumour necrosis factor-alpha (TNF-α), interleukine-6 (IL-6) and C-reactive protein (CRP), using immunocytochemistry (ICC) and immunofluorescence capture of blood cells in cell blocks. ICC is performed mainly during routine cytological examinations, whereas the use of cell blocks in blood examination is uncommon. Insofar as we know, this is the first study using cell block techniques on canine blood samples. Three commercially available antibodies against TNF-α, IL-6 and CRP, forming two panels, were evaluated. A standard streptoavidin-biotin complex technique was used for ICC. TNF-α and IL-6 labelling was scored for colour and intensity, and CRP for immunofluorescence capture. TNF-α and IL-6 colour and intensity scores differed significantly between the PG and CG groups, and were higher in PG before OVH (P<0.01, P<0.01, P<0.001, P<0.01, respectively). IL-6 intensity was significantly greater in PG 15 days after OVH (P<0.05). CRP capture in PG was strong before OVH and high in both groups 15 days later. Low-dose anti-inflammatory agents or an anti-cytokine therapy may be useful in pyometra treatment in the future because these treatments may offer protection from systemic inflammatory response syndrome before and after OVH. .

Utility of Cytospin and Cell block Technology in Evaluation of Body Fluids and Urine Samples: A Comparative Study.

Background:Cytologic examination of body fluids commonly involves the use of direct or sediment smears, cytocentrifuge preparations, membrane filter preparations, or cell block sections. Cytospin and cell block techniques are extremely useful in improving cell yield of thin serous effusions and urine samples, and ensure high diagnostic efficacy.Materials and Methods:We studied cytospin preparations and cell block sections prepared from 180 samples of body fluids and urine samples to compare the relative efficiency of cell retrieval, preservation of cell morphology, ease of application of special stains, and diagnostic efficacy. Samples were collected and processed to prepare cytospin smears and cell block sections.Results:We observed that overall, cell yield and preservation of individual cell morphology were better in cytospin preparations as compared to cell blocks, while preservation of architectural pattern was better in cell block sections. The number of suspicious cases also decreased on cell block sections, with increased detection of malignancy. It was difficult to prepare cell blocks from urine samples due to low cellularity.Conclusions:Cytospin technology is a quick, efficient, and cost-effective method of increasing cell yield in hypocellular samples, with better preservation of cell morphology. Cell blocks are better prepared from high cellularity fluids; however, tissue architecture is better studied, with improved rate of diagnosis and decrease in ambiguous results. Numerous sections can be prepared from a small amount of material. Special stains and immunochemical stains can be easily applied to cell blocks. It also provides a source of archival material.

Diagnostic utility of CD10 immunohistochemical staining on cellblock in differentiating hepatocellular carcinoma from secondary malignancies of liver.

Differentiation of hepatocellular carcinoma (HCC) from metastatic malignancy in liver may be difficult at times on fine-needle aspiration cytology, especially in case of moderate-to-poorly differentiated tumors. The benefit of cell-block technique is the recognition of histologic pattern of diseases along with application of a wide variety of immunohistochemical (IHC) stains to differentiate hepatic malignancies. In this study, CD10 IHC staining was done on cellblocks prepared from aspirates of clinicoradiologically/cytologically suspected malignant liver neoplasms to differentiate HCC from malignancies metastasizing to liver. The objective of the study was to assess the diagnostic utility of CD10 IHC stain on cell-block preparation for differentiating primary from Secondary malignancies of liver. Formalin-fixed, paraffin-embedded cellblocks of 61 cases (25 cases of HCC and 36 cases of metastatic carcinoma) were prepared from a fine-needle aspirate of the suspected malignant liver neoplasm and immunostained using monoclonal antibody against CD10. Twenty-two (88%) of 25 cases of HCC were positive for CD10 with a canalicular staining pattern. Two (8%) were positive for CD10 with membranous and one (4%) with cytoplasmic staining pattern. CD10 immunostaining on cellblock is useful in discriminating HCC and metastatic carcinoma of the liver with a diagnostic accuracy of 88.52%.

Diagnostic Utility of Cell Block Preparation of Fine Needle Aspiration Material

In routine FNAC, 15 to 20% are classified as non-diagnostic due to scanty cellullarity. Cell blocks can be prepared from the residual material of FNA obtained by flushing the needle hub. This ensures maximum utilization of all available material. This work aims to study comparative cytopathology in conventional smears & Cell blocks & the advantages and disadvantages of cell block technique over conventional smears. Present study was cross sectional study carried in a tertiary care hospital. Routine FNAC was done on 270 patients, cell blocks were made from residual material left behind after preparing conventional cytology smears. Conventional FNAC smears were adequate in 221 and Cell blocks in 214 cases. In 199 cases both conventional FNAC smears and Cell blocks were adequate, while in 22 only conventional smears were adequate and in 15 only Cell blocks were adequate. Adequacy of conventional FNAC smears and Cell Blocks were 81.85% and 79.25% respectively. Combined adequacy rate of conventional FNAC smears and Cell blocks was 87.40%. The study concluded that Cell blocks from the FNA material remaining in hub or syringe, after conventional smear preparation increases cellular yield, architectural pattern & add to diagnostic efficacy of smear preparation of same patient without repeating the FNA or incurring an additional procedure.

The diagnostic value of tissue button technique for specimen accusation during endobronchial ultrasound-guided transbronchial fine-needle aspiration.

The quality of tissue acquisition during endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a major determinant of the diagnostic yield of the procedure. In the tissue button (TB) technique, the retrieved cellular specimen is fixed in ethanol and subsequently scraped from slide using surgical blade into formaldehyde and processed like ordinary tissue biopsy thus potentially increasing its diagnostic value. To retrospectively evaluate the diagnostic yield of a TB technique in patients undergoing EBUS-TBNA for various malignant and benign conditions. The diagnostic yield of specimen obtained by two methods (TB and traditional cell-block technique) performed during the same procedure are outlined in 46 patients who underwent EBUS-TBNA (median age = 65, range 19-85 years). Overall, in both malignant and benign conditions, TB resulted in clear diagnostic material in 43/46 (93.4%) patients. Specifically, TB provided clear histological diagnosis of malignancy (either primary lung cancer or metastases from extra-thoracic cancer) in 30/46 (65.2%) patients and granulomatous inflammation in 11/46 (23.9%) of patients. Only in two patients TB did not provide diagnostic material. The newly introduced TB technique provides valuable histological diagnostic material during EBUS-TBNA both malignant and benign conditions. Given its simplicity and its high diagnostic yield, TB should be considered to be used as one of the preferred specimen acquisition modalities during EBUS-TBNA specimen processing. Direct comparison to alternative tissue processing techniques during EBUS-TBNA should be explored in further randomized prospective studies.

Modified Alcohol-Formalin Cell Block Technique in Head and Neck Pathology Diagnosis

Objectives: Cell block preparation is a recognized technique in histopathological diagnosis. This technique aids in maintaining an intact architecture and reducing the diagnostic errors associated with fine-needle aspiration cytology. Numerous techniques have been put forth, but the need for an optimal technique for routine use in the laboratory still persists. The aim of our study was to establish a cell block technique which aids in the accurate diagnosis of head and neck pathology. Methodology: A modified cell block technique was developed using alcohol-formalin as a fixative. Forty fine-needle aspiration fluids from clinically and radiologically diagnosed cases of head and neck pathology were used as samples. The cell block sections were compared with the cytology smears to determine the utility of the technique. Results: The cell blocks presented with better preservation of the architectural framework and enabled a quick diagnosis. Cellular clumping was negligible, and nuclear as well as cellular details were maintained similar to tissue sections. It led to the integration of conventional techniques using 10% neutral buffered formalin with that of the 10% alcohol-formalin technique. Conclusion: Modified cell block technique can be used as a simple and effective tool in the routine diagnosis of head and neck pathology.

A comparative study of conventional cytology and cell block method in the diagnosis of pleural effusion.

In a patient with pleural effusion, cytological study (CS) is one of the most useful investigations, especially when malignancy is suspected. Instead of applying only CS, the pleural fluid can be further processed using the cell block (CB) technique, which may augment the diagnostic utility. The aim of this study was to compare the diagnostic yields of CS, CB, and the combination of both, regardless of the etiology of pleural effusion. A cross-sectional study was conducted on patients with pleural effusions who underwent thoracentesis from June 2015 to May 2016. All samples were submitted for routine biochemical analysis, CS, and CB histology. The results of cytopathological studies were compared to the final diagnoses. Out of a total of 353 samples, the final diagnoses included 278 (78.8%) malignancies, 41 (11.6%) infectious diseases, 16 (4.5%) other inflammatory diseases, and 18 (5.1%) transudative pleural effusions. CS and CB provided a similar diagnostic yield (48.7% vs. 49.9%, P=0.69), while the combination of both gave a higher yield (57.2%) (P<0.001, compared with CS). Among 278 malignant pleural effusions (MPE), the diagnostic yields of CS and CB were 61.2% and 61.9%, respectively. Combined CS and CB improved the diagnostic yield to 71.2% (P<0.001). However, both CS and CB had low diagnostic yields in infectious pleuritis, other inflammatory diseases, and transudative pleural effusions. In MPE, CB provides a similar diagnostic performance to CS, while application of both techniques can significantly increase the diagnostic yield. However, in other pleural diseases, CB and CS had limited values in diagnosis.

THE FINE NEEDLE ASPIRATION AS AN AUXILIARY METHOD FOR THE DIAGNOSIS OF KERATOCYSTIC ODONTOGENIC TUMOR: A CASE REPORT

A 19-year-old male patient was referred to a maxillofacial surgeon with a lesion in the anterior jaw region involving an included tooth, with 1 year of evolution. Radiographically, the lesion showed radiolucent aspect, unilocular, measuring about 10 cm long. Clinical diagnostic hypotheses were ameloblastoma, keratocyst odontogenic tumor and odontogenic myxoma. A fine needle aspiration was chosen to be performed and the material was processed for analysis through the cell block technique. Cytology showed lumpy material intermingled with squamous, parakeratotic and xanthomatous cells among granulocytes and numerous red blood cells, presenting the diagnosis of cystic lesion with epithelial appearance. Then, the incisional biopsy was performed and the histologic examination revealed a cavity lined by parakeratinized stratified squamous epithelium, with corrugated surface and the basal cell layer arranged in palisade, establishing the diagnosis of keratocystic odontogenic tumor. The patient was referred to the maxillofacial surgeon to complete removal of the lesion.

Comparative study of cell block versus centrifuged smear examination from aspirates of cystic lesions

Background: Cystic fluids encountered during routine FNA poses a diagnostic challenge to cytopathologists due to its low cell yield with high dispersal of cells on conventional centrifuged smears (CS). Cell Block (CB) technique enables retrieval of small tissue fragments from fluids, thereby providing scope for better morphology and material for ancillary techniques which help in improving the diagnosis. Aim : To compare the efficacy of CB versus CS, in cyto-diagnosis of cystic lesions. Methods : This observational study was conducted on a total of 50 fluid samples aspirated from cystic lesions during routine FNA and fluids aspirated peri-operatively from cystic ovarian lesions. Divided into two equal parts, one part was processed for CS and CB by Fixed Sediment Method and relevant immunohistochemistry was performed. CSs were categorized as positive for malignancy, benign diagnosis, Inadequate for opinion and suspicious for malignancy. CBs were categorized as; no material, Non-contributory (CS+, CB-), confirms the smear diagnosis and establishes a specific diagnosis. The comparison between CS and CB was analysed by Chi- square test & kappa test. Results: Out of the 50 cases, 35(70%) were given a benign diagnosis, 10 (20%) were positive for malignancy, 2(4%) were suspicious and 3(6%) were inadequate for opinion on CS. In CB out of 50 cases, 29 of them confirmed/established a diagnosis and 21 cases were non diagnostic / non-contributory. CB gave an improved diagnosis in 2 out of 10 (20% ) malignant cases and 2 out of 35 (5.7%) benign cases.( p value = 0.00054, Kappa value =0.34) Conclusions: CBs complemented CS, more so in malignant lesions by preserved architecture. Aspirates from multiple sites of the cystic lesions (with/without radiological assistance) pooled as one specimen yielded better material for CBs and ancillary techniques like histochemistry and IHC. DOI: 10.21276/APALM.1249

Cell tube block: a new technique to produce cell blocks from fluid cytology samples.

Cell blocks are widely used in human cytopathology. Several techniques have been proposed to convert fluid specimens into solid material, which after embedding in paraffin can be used for histochemistry, immunohistochemistry, or molecular testing. In contrast, only in the last few years, have cell blocks begun to be used in the veterinary field. The purpose of the study was to present the production and features of cell tube blocks (CTB) with veterinary liquid samples. Liquid samples including cerebrospinal fluid, cutaneous cyst fluid, pericardial and pleural effusions, bronchoalveolar lavage, urine, and blood were centrifuged in a microhematocrit centrifuge. Capillary tubes were broken at the liquid-solid interface and fixed in 10% formalin for 24 hours. After paraffin embedding, sections of CTB were used for different stains including immunohistochemistry. The morphology and cellular detail in CTB sections were comparable to conventional histologic sections and other existing cell block techniques. The use of special stains such as Gram, Giemsa, alcian blue, and periodic acid-Schiff was straightforward, and immunohistochemistry results with antibodies to pan-cytokeratin, PAX-5, and CD3 were considered good. The CTB method was easily implementable under practice conditions (up to the fixation of the microhemtocrit tube), analogous to surgical biopsy submission for histology. Cell tube blocks can increase diagnostic accuracy when the technique is used in tandem after the cytologic evaluation, and the technique allows storage of fluids. Other advantages of CTB were the simplicity, low cost, and separation of erythrocytes from the nucleated cells, which was helpful in hemodiluted samples.

Utility of cell block to detect malignancy in fluid cytology: Adjunct or necessity?

Cell block (CB) technique when supplemented with conventional smear, provides increased cellularity, preservation of architectural pattern with excellent morphology, and a clear background. We compare the utility of CB technique compared to conventional smear in detection of malignancy in serous effusions. An institution-based observational and analytical study was carried out over 1 year on 50 patients with effusions. The residual amount of centrifuged deposit after preparation of conventional smear was mixed with 10% alcohol-formalin solution, and CBs were prepared. Calretinin and cytokeratin 5 were used for reactive mesothelial cells and Wilms tumor 1, thyroid transcription factor 1, CDX2, and estrogen receptor were used to confirm the adenocarcinoma cells. Maximum patients belonged to the age group of 61-70 years. Male:female ratio 1:1.17. Most common cause of malignant peritoneal effusion was due to ovarian malignancies in females and adenocarcinoma of stomach in males while, in case of pleural effusion, it was breast carcinoma in females and lung carcinoma in males. Thirteen suspicious cases were subjected to immunohistochemistry (IHC). In 70% cases, CB findings were consistent with the findings of conventional smears. In 20% cases, the conventional smears were suspicious for malignancy, and malignancy was confirmed by CB technique, whereas in 10% cases, both smears and CB were suspicious for malignancy and the original nature of the lesion was confirmed by the IHC. Sensitivity and specificity of CB compared to conventional smear were 88.88% and 86.98%, respectively. CB produced significantly better results (P = 0.0271) while detecting malignant lesions and reducing suspicious results (P = 0.0226).