DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20203031

Diagnostic utility of cytospin, cell block and immunocytochemistry in pleural effusion cytology

Nounechutuo Miachieo, Madhu Kumar, Mala Sagar, Malti Kumari Maurya, Santosh Kumar, R. A. S. Kushwaha, Madhu Mati Goel

Abstract


Background: With the introduction of cytospin, the sensitivity of diagnosing malignancies has increased mainly due to the increase in cellular yield. Cell block also gives the advantage of ancillary testing and allows for retrospective studies. Immunocytochemical markers are used to differentiate and subtype various malignancies in body effusions.

Aim of the study was to compare the morphological features of both technique and to assess the diagnostic utility of cell block methods in the cytodiagnosis of pleural effusions.

Methods: This was a Prospective observational comparative study of two cytopreparatory techniques. All samples were examined and processed by cytospin and cell block techniques. Continuous data were expressed as Mean±SD (standard deviation) while categorical data were expressed in number, percentage and compared by chi-square (χ2) test.

Results: The final diagnosis of both cytospin (147 cases) and cell block (150 cases) techniques was divided into four broad categories: Inadequate, Benign, Suspicious and Malignant. The significant diagnostic cytospin (AUC=0.857, p<0.001) in discriminating positive and negative malignant cases with 75.00% sensitivity (95% CI=53.3-90.2) and 100.00% specificity (95% CI=86.7-100.0) and with 100.0% positive predictive value and 81.2% negative predictive value. In contrast, cell block also showed significant diagnostic but with higher accuracy (AUC=1.000, p<0.001) and sensitivity 100.00% (95% CI=86.7-100.0) and specificity 100.00% (95% CI=86.7-100.0) and 100.0% positive predictive value and 100.0% negative predictive value than cytospin technique.

Conclusions: Cell block as a technique should be used in routine practice as it not only increases the diagnostic yield but ancillary test can also be done.


Keywords


Cell block, Cytospin, Immunocytochemistry, Pleural fluid

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References


Marel M, Stastny B, Melinova L, Svandova E, Light RW. Diagnosis of pleural effusions. Experience with clinical studies 1986-1990. Chest 1995; 107:1598-603.

Cibas ES, Ducatman BS. Pleural, Pericardial, and Peritoneal Fluid. In E.S.Cibas, Cytology: diagnostic principles and clinical correlates, 3rd ed. Philadelphia: Saunders Elseiver; 2009:129-54.

Nair GG, Manjula AA. Comparative study of cell blocks & routine cytological smears of pleural & peritoneal fluids in suspected cases of malignancy. Indian J Pathol Oncol. 2015;2:61-8.

Kushwaha R, Shashikala P, Hiremath S, Basavaraj HG. Cells in pleural fluid and their value in differential diagnosis. J Cytol. 2008;25:138-43.

Joshi A, Mahajan N, Karmarkar PJ, Mahore SD. Diagnostic utility of various techniques used in body fluid cytology. J Dent Med Sci. 2014;13:13-8.

Singh M, Khan L, Verma YN, Sachan N, Pantola C, Pathak A, et al. Comparative study for the use of different techniques in serous fluid cytology. J Evalu Medical Dent Sci. 2015;4:3154-61.

Mulkalwar M, Chandrakar J, Kujur P, Gahine R, Swarnakar S, Bhaskar LVKS. Diagnostic Utility of Cell Block Method versus Cytospin Method in Pleural and Peritoneal Fluid Cytology. J Med Sci Clini Res. 2016;4:13726-32.

Bista P. Comparison of the diagnostic accuracy of cell block with cytology smear in serous effusions. J Pathol Nepal. 2013;3:482-6.

Dekker A, Bupp PA. Cytology of serous effusions. An investigation into the usefulness of cellblocks versus smears. Am J Clin Pathol. 1978;70:855-60.

Khan N, Sherwani KR, Afroz N, Kapoor S. Usefulness of cellblocks versus smears in malignant effusion cases. J Cytol. 2006;23:129-32.

Shubhada B, Kumbalkar D, Nayak S. Evaluation of Cell Block Technique in the Cytodiagnosis of Body Fluids. Int J Sci Res. 2015;4:87-94.

Pawar S, Sameer MA, Ahuja M, Patil A. Sensitivity and Specificity of Cell Block Method in Diagnosis of Lung Malignancies. J Dent Med Sci. 2016; 15:86-99.

Madakshira MG, Kolavadi SS, Varma V, Bharadwaj R. Cell Block- A Useful Adjunct in Cytopathology of Serous Effusions. Nat J Lab Med.2017;6:26-31.

Shivakumarswamy U, Arakeri SU, Karigowdar MH, Yelikar BR. Diagnostic utility of the cell block method versus the conventional smear study in pleural fluid cytology. J Cytol. 2012;29:11-5.

Santwani PM, Vachhani JH. Analysis of diagnostic value of cytological smear method versus cell blocks method in body fluid cytology: Study of 150 cases. Ethiop J Health Sci. 2014;24(2):125-30.

Pal S, Goswami BK. Pleural fluid cytology in suspected malignant effusions with special emphasis on cell block preparation. J Dent Med Sci. 2015;14:13-6.

Afify AM, al-Khafaji BM. Diagnostic utility of thyroid transcription factor-1 expression in adenocarcinomas presenting in serous fluids. Acta Cytol. 2002;46:675-8.

Khoor A, Byrd-Gloster AL, Nicosia SV. Expression of thyroid transcription factor-1 in malignant pleural effusions. Pathol Oncol Res. 2011;17:263-7.

Fetsch PA, Abati A. Immunocytochemistry in effusion cytology, a contemporary review. Cancer Cytopathol. 2001;93:293-308.

Thapar M, Mishra RK, Sharma A, Goyal V, Goyal V. Critical analysis of cell block versus smear examination in effusions. J Cytol. 2009;26:60-4.

Köksal D, Demirağ F, Bayiz H, Koyuncu A, Mutluay N, Berktaş B, et al. The Cell Block Method Increases the Diagnostic Yield in Exudative Pleural Effusions Accompanying Lung Cancer. Turk J Pathol. 2013;29:165-70.