Cell Block or Centrifuged Smear: A Comparative Study from a Tertiary Care Center

Cellblock technique (CB) is one of the oldest techniques of preparing materials for microscopic examination by paraffin embedding of sediments of fluids. CB enables retrieval of small tissue fragments from fluids, improving the cellular yield and diagnostic accuracy. The main advantage of CB is the potential to make many sections for special stains and ancillary techniques like IHC. Objective: To compare the efficacy of cellblock vs. centrifuged smear examination in effusions and fluids from cystic lesions. Methods: A total of 220 samples which included effusions (pleural, peritoneal, pericardial and synovial fluids), CSF, BAL fluids and fluids from cystic lesions were studied and categorized by both routine centrifuged smear and cellblock preparation by fixed sediment method. For CB categorization, volume of fluid and presence of pellet were given due importance. Results: Majority of the samples were pleural fluids (34.1%) followed by peritoneal fluids (29.1%) and fluids from cystic lesions (22.1%). Male to female ratio was 1.2:1 with peak age between 40- 70 years. On CS 86.8% were benign, 1.8% were suspicious for malignancy, 8.2% were positive for malignancy and 3.3% were inadequate for opinion. CBs were non-contributory in 65.9%, in 27.2%, CBs confirmed CS diagnosis and in 4.5% they established a specific diagnosis. (Sensitivity 63%, specificity 71.7%, PPV 80%, NPV 94.6%)(Kappa value = 0.175, p value=0.001). Volume of the fluid did not matter in malignant effusions and material on CB was seen in majority of these fluids with the presence of pellet formation.Among the non-neoplastic fluids material on CB was seen with volume >10ml with a good pellet formation. Conclusion: CBs were complementary to CS in the overall categorization of benign and malignant groups. However, they appeared to be more useful in diagnosis of malignancy by better-preserved architectural patterns and provided material for ancillary techniques like histochemistry and IHC.In CB, presence of pellet after centrifugation may be an indicator for the availability of material.

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

Background: 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. Objective: 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. Materials and Methods: 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. Results: 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. Conclusion: CD10 immunostaining on cellblock is useful in discriminating HCC and metastatic carcinoma of the liver with a diagnostic accuracy of 88.52%.

IDENTIFICATION OF CANINE VISCERAL LEISHMANIASIS IN A PREVIOUSLY UNAFFECTED AREA BY CONVENTIONAL DIAGNOSTIC TECHNIQUES AND CELL-BLOCK FIXATION

After the report of a second case of canine visceral leishmaniasis (CVL) in São Bento da Lagoa, Itaipuaçu, in the municipality of Maricá, Rio de Janeiro State, an epidemiological survey was carried out, through active search, totaling 145 dogs. Indirect immunofluorescence assay (IFA), enzyme-linked immunosorbent assay (ELISA), and rapid chromatographic immunoassay based on dual-path platform (DPP(r)) were used to perform the serological examinations. The parasitological diagnosis of cutaneous fragments was performed by parasitological culture, histopathology, and immunohistochemistry. In the serological assessment, 21 dogs were seropositive by IFA, 17 by ELISA, and 11 by DPP(r), with sensitivity of 66.7%, 66.7% and 50%, and specificity of 87.2%, 90.2% and 94%, respectively for each technique. The immunohistochemistry of bone marrow using the cell-block technique presented the best results, with six positive dogs found, three of which tested negative by the other parasitological techniques. Leishmania sp. was isolated by parasitological culture in three dogs. The detection of autochthonous Leishmania infantum in Itaipuaçu, and the high prevalence of seropositive dogs confirm the circulation of this parasite in the study area and alert for the risk of expansion in the State of Rio de Janeiro.

Diagnostic Accuracy of Brush Cytology with Direct Smear and Cell-block Techniques according to Preparation Order and Tumor Characteristics in Biliary Strictures / 대한소화기학회지

BACKGROUND/AIMS: There are few data supporting the diagnostic yield of brush cytology depending on the order of cytologic preparation method or the location or shape of tumors in biliary strictures. We investigated diagnostic yields and variations in brush cytology with direct smear and cell-block preparations according to sampling preparation sequence and tumor location and shape in biliary strictures. METHODS: Patients who had undergone ERCP with tissue sampling between August 2009 and April 2013 were analyzed retrospectively. Group A was examined using brush cytology with direct smear followed by cell-block with or without biopsy, while the reverse order was performed for group B. RESULTS: Among 138 enrolled patients, 92 patients (A: 36, B: 56) underwent both brush cytology with direct smear and cell-block preparations. No differences in sensitivity, specificity, or accuracy were observed according to the sampling preparation method and the location or shape of tumors in biliary strictures. The cellularity observed from brush cytology with direct smear was better than that from cell-block according to the location of the tumor (p<0.01). The diagnostic yield was increased in both groups with addition of an endobiliary biopsy. CONCLUSIONS: No difference in diagnostic accuracy was observed between the sequences of preparation for brush cytology with direct smear and cell-block techniques. Brush cytology showed better cellularity for diagnosis.