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Objectives Endocervical curettage (ECC) specimens may be limited by scant tissue. We evaluated whether a cellular concentration processing method could improve their diagnostic quality. Methods Between October 2018 and June 2019, ECC specimens were assigned chronologically to one of two groups: nonconcentrated ECC (NECC) or concentrated ECC (CECC). NECC specimens underwent routine histologic processing. CECC specimens were processed using a published HistoGel-based cell block method. We reviewed diagnoses for ECCs, concurrent cervical biopsies and/or loop electrosurgical excision procedures (LEEPs), and preceding Papanicolaou (Pap) smears. We performed multivariate logistic regression analyses to evaluate the impact of processing method on ECC adequacy and discordance between Pap smear and worst tissue diagnoses. Results NECC and CECC adequacy was 88.2% and 84.7% (P = .06). ECC adequacy was greater if concurrent biopsy/LEEP was performed (odds ratio [OR] = 1.76, P < .01). Discordance between Pap smear and worst tissue diagnoses was 9.5% and 13.3% (P = .04) for cases with NECC and CECC processing, although processing method was not significant in multivariate analysis (OR = 0.74, P = .11). Adequate ECC sampling and concurrent biopsy/LEEP were independently associated with concordance between Pap smear and worst tissue diagnosis (OR = 0.46, P < .01 and OR = 0.65, P = .02). Conclusions ECC processing method did not significantly affect either specimen adequacy (P = .06) or diagnostic discordance (P = .11) when controlled for other factors.

ObjectivesThis study aimed to determine whether Ki-67 index evaluated on cytologic material could reliably grade pancreatic neuroendocrine tumors (PanNETs).MethodsCases with adequate cell block and available surgical specimens were included. Ki-67 index was calculated using “eyeballing,” “hot spot,” and “complete” counting methods.ResultsThe overall concordance rates between cytology and surgical specimens were 71%, 73%, and 59%, respectively, by using eyeballing, hot spot, and complete counting approaches. All grade 1 tumors were correctly graded on cytology, but in grade 2 tumors concordance rates were only 36%, 41%, and 9%, respectively. All grade 2 tumors were undergraded when cell blocks contained fewer than 1,000 cells, while concordance rate increased to 57%, 64%, and 14%, respectively, in cases with 1,000 cells or more.ConclusionsGrade 2 PanNETs can be significantly undergraded when Ki-67 index is evaluated on cell block material. In cases with 1,000 or more cells, the hot spot counting method has better correlation with surgical specimens.

Objectives The specific aims of the study are to determine skillsets most valuable to regional employers of cytotechnologists and assess the employers’ willingness to use graduating MS cytology practitioners in the expanded scope of practice. Methods Data from the greater New York region were collected via a web-based survey distributed to a broad sample of laboratory professionals involved with hiring in a variety of institutions. Results The three skillsets most important to New York employers and most employable are fine-needle aspiration adequacy assessment, regulatory acumen, and prescreening cell blocks. The skills that are of least important and least employable are prescreening high-volume tissue biopsy specimens and histology. Conclusions The results of this survey shed light on regional employers’ perspectives regarding the skillsets that are most important and marketable in the greater New York region and may be useful for subsequent curriculum development.

Objectives The plasma-thrombin method is commonly used to make cell blocks from fine-needle aspiration (FNA) samples but requires centrifugation. We describe a modification to this method that does not require centrifugation for use in resource-limited settings. Methods Pooled fresh plasma is aliquoted into 2-mL Eppendorf tubes and the FNA sample directly rinsed into the plasma. Two drops of reconstituted thrombin are added and gently mixed. A cell clot is transferred to a tissue bag, fixed in formalin, and processed. This method was applied to FNA samples from 44 patients presenting to the Mbarara University of Science and Technology FNA clinic. Results The cell blocks were less cellular than the smears but contained adequate material to confirm morphologic impression or perform immunocytochemistry in 36 of 44 cases (82% adequacy rate). Conclusions The modified plasma-thrombin method is a reliable cell block preparation method that can be easily applied in resource-limited settings.

Objectives Programmed death-ligand 1 (PD-L1) is an emerging molecular target in anticancer therapy, most notably non–small cell lung cancers. PD-L1 expression in pancreatic adenocarcinomas (PDAs) on surgical specimens is highly variable, with 10% to 60% of tumors showing expression. PD-L1 expression in PDA on endoscopic ultrasound-guided fine needle aspirations (EUS-FNAs) has been rarely studied. Methods Formalin-fixed, paraffin embedded (FFPE) cell blocks (CBs) from 65 EUS-FNA samples of 55 patients, with a diagnosis of PDA, with at least 20% tumor cellularity were retrieved. The cell blocks were originally fixed in CytoRich fixative. Immunohistochemical staining (IHC) for PD-L1 was performed using the M365329-1 (22C3) clone according to the manufacturer’s approved protocol and optimized for the fixation method using appropriate controls. A combined positive score (CPS) defined per CAP guidelines as the total number of positive tumor cells and inflammatory cells as a percentage of the total number of tumor cells was assessed for each case and was grouped as 20. Results Twenty-five samples (38%) from 21 patients showed immunoreactivity to PD-L1, with 21 (32%) having a CPS of Conclusion Immunohistochemical analysis for PD-L1 is feasible on EUS-FNA CB samples when optimized and validated for the fixation method using appropriate controls. PD-L1 expression is seen in only a minority of PDAs, albeit with a very low CPS. The potential role of PD-L1 as a prognostic marker for disease progression needs further exploration.

Cell blocks prepared from residual tissue fluids and fine-needle aspirations can be useful adjuncts to smears for establishing a more definitive cytopathologic diagnosis. They can be particularly useful for categorization of tumors that otherwise may not be possible from smears themselves. A modified cell block technique using an improvised ethanol formalin fixative (Nathan alcohol formalin substitute) followed by a simple paraffin processing schedule is described. This improved preparation offers excellent cytomorphologic features corresponding closely to cells in Papanicolaou-stained smears and ensures optimal preservation of histochemical and immunocytochemical properties. The technique is simple and reproducible and uses routine safe laboratory chemicals. The efficacy of cell blocks also is discussed.

SOX10 is a transcription factor expressed from the developmental stage to adulthood in acinar and intercalated ducts of major salivary glands, and in some salivary gland tumors. Its role in cytologic specimens has been rarely documented. This study was performed to evaluate its utility in the diagnosis of salivary gland oncocytic tumors on fine …

Astrocyte elevated gene-1 (AEG-1) is an oncogene that plays an important role in the development and progression of hepatocellular carcinoma (HCC). Its usefulness in diagnosing HCC in fine needle aspiration (FNA) cell blocks (CB) is not well documented. The purpose of this study was to determine the utility of AEG-1 in …

Large-volume effusions are often sent to cytology. Cell blocks of these specimens allow for immunohistochemistry and molecular testing. However, with a large volume and small concentration of diagnostic cells, preparing a cell block can be difficult. Here we present a method for improving cell block cellularity without significantly increasing cost or turnaround time. We analyzed nine specimens received in August 2014. All …

In the current era of minimally invasive techniques for obtaining tissue samples for diagnosis and prognosis there is a need for methods to use “limited material” specimens for preclinical investigation. In the current study, we investigated methanol-fixed paraffin-embedded (MFPE) cell blocks for protein yield employing the Cellient automated cell block system. This system utilizes methanol fixation …

Cell blocks from fine-needle aspiration (FNA) provide sources for ancillary studies. Materials from FNA could be very limited and a processing protocol maximizes cell harvest on cell block and slide is required. FNA materials are routinely prefixed in either cytolyte or 10% neutral …

A retrospective analysis was done of a novel method for processing body fluid cytology in regards to cell-block cellularity, background quality, and immunohistochemical staining. Body cavity fluids (n = 20) received at our institution were selected at random. Each body fluid specimen was mixed thoroughly by vortexing. Next, two 30-mL samples were collected and processed according to the standard (method A) and novel method (method B) for cell-block preparation. In regards to method A, 30 mL …

Approximately half of 351 body-cavity effusions from 263 patients were examined prospectively in paraffin-embedded cell blocks and in smears, while the other half were examined in smears alone. The number of suspect and positive fluids obtained with the combined cell block-and-smear technic was double that of specimens examined in smears only. No false-positive case was found. Tumors were subsequently demonstrated in 38% of the patients who had negative or atypical cytologic reports. Smears stained with the Papanicolaou technic generally have good definition of malignant cellular changes, wheras cell blocks are particularly useful when the cytologic abnormalities are misleading, such as in reactive mesothelial cells, or obscure, as in occasional well-differentiated adenocarcinomas. It is recommended that both cell blocks and smears be used in evaluating all fluids submitted to the cytology laboratory.

Fifty-nine successive cases of fine-needle aspiration (FNA) of the liver were reviewed to determine the efficacy of various rinse and smear preparations in rendering a diagnosis of cancer. Preparations included Papanicolaou- and Diff-Quik®-stained smears, Millipore® filters, cytocentrifugation, and cell blocks. Of 33 of 59 cases diagnostic for cancer, 90% were positive on rinse, 78% on smear, and 69.6% on both rinse and smear. Seven cases (21.2%) were diagnostic on rinse preparation only and would otherwise have been interpreted as equivocal. Papanicolaou smears and cell block rinses were most valuable to evaluate malignancy in the liver, using the FNA technic. The authors believe rinse preparations justify their cost for assessment of cancer and are essential to establish the diagnosis in a significant number of cases.

Taenia solium infection is endemic in Asia and cysticercosis is not uncommon. The authors report a case of cysticercosis diagnosed by fine needle aspiration using a cell block. The authors believe it to be the first such case so diagnosed.