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The identification of non-hematopoietic cells in effusions is a diagnostic challenge in cytology. Biopsies from mesothelium or primary lesions are infrequently performed in clinical settings and immunochemistry on smears or immunohistochemistry on cell blocks are the most common ancillary test to refine the cytological diagnosis. Cavitary effusions are an ideal matrix for flow cytometry and the availability of a cytometric panel to describe non-hematopoietic cells would represent a useful tool. Here we present the results of the flow cytometric and immunohistochemical determination of cytokeratin (CK), vimentin (VIM) and desmin (DES) in 36 canine effusions. The concordance between the two methods was perfect for CK (100%), substantial for VIM (77.8%), and almost perfect for DES (97.2%). The panel was interpreted to define the epithelial (CK+VIM-DES-), mesothelial (CK+VIM+DES+), or mesenchymal (CK-VIM+DES-) origin of the cells. Unexpected profiles were considered doubtful and observed patterns were individually discussed. The concordance of the panel interpretation between two methods was 75%. The evaluation of discordant and doubtful cases suggests a lower sensitivity of flow cytometry in detecting VIM expression and revealed a high frequency of VIM+ epithelial cells, variable expression of VIM in mesothelial cells, and an important role of DES in excluding an epithelial origin when positive. Multicentric studies based on histopathological diagnoses are necessary to confirm these findings and evaluate the diagnostic utility of the panel to refine cytological diagnosis. Our results show that flow cytometry can be a timesaving alternative to IHC on cell blocks in clinical settings to detect CK, VIM and DES expression. The interpretation of the panel is similar in most cases; however, occasional discordant results, particularly for VIM, may occur. [ABSTRACT FROM AUTHOR]

Introduction: A palpable breast lump is a common diagnostic problem for clinicians and surgeons. Fine-needle aspiration cytology (FNAC) has many advantages such as less cost, less sample processing time, less pain, less chance of hematoma, and less discomfort. FNAC with cell block preparation further increased both sensitivity and specificity by nearly 100%. With the cell block preparation, we can also use newer tests like estrogen receptor–progesterone receptor–human epidermal growth factor receptor 2. Aims: The aim of this study was to derive conclusions about the correlation, including sensitivity, specificity, positive and negative predictive values (NPVs), and the diagnostic accuracy of FNAC, with or without cell blocks, compared to the final histopathology in cases of palpable breast masses. Materials and Methods: A cross-sectional prospective study was conducted after getting approval from the Human Ethics Research Committee from January 2018 to December 2019, which included 65 patients. Patients diagnosed clinically for breast lumps who underwent diagnostic FNAC with cell block, followed by a histopathological examination at our hospital, were included in the study. Results: FNAC without cell block sensitivity, specificity, positive predictive value (PPV), NPV, efficiency rate, and diagnostic accuracy are 91.3%, 100%, 100%, 90.1%, 86.2%, and 96.5%, respectively. FNAC with cell block sensitivity, specificity, PPV, NPV, efficiency rate, and diagnostic accuracy are all 100%. All of our results beat the standard estimate. Conclusions: Fine-needle aspiration cytology is a patient-friendly, easy, reliable, repeatable, and simple diagnostic test. Whenever it is combined with cell block preparation, improves the accuracy of FNAC diagnosis which is more accurate and comparable to golden-standard biopsy with histopathology examination.

Background: Epidermal growth factor receptor (EGFR) mutations in non-small-cell lung carcinomas (NSCLC) are a frequent class of driver mutations, and tyrosine kinase inhibitor (TKI) therapy provides considerable clinical benefits. Using the most effective and also easiest method for EGFR analysis is cost-effective and time-saving. In this study, we aimed to determine which method could be more effective by comparing the incidences of EGFR mutations in cytological and histological samples which were obtained by different methods also, whether there was a difference in the incidences of EGFR mutations between the primary foci, mediastinal lymph nodes, and distant metastatic foci. Materials and Methods: We retrospectively reviewed 420 cases of cytological materials, small biopsies, and surgical samples reported as NSCLC underwent EGFR analysis in our department between 2016 and 2022. We collected the data and interpreted the results from two different perspectives. Results: We identified 36 EGFR mutations in 362 biopsies (9.94%) and 17 in 58 cytology samples (29.31%). There is a significant difference between the two methods (P = 0.01*). We observed 38 EGFR mutations in 320 primary foci (11.87%), 7 EGFR mutations in 36 mediastinal or subcarinal lymph nodes (19.44%), and 8 EGFR mutations in 64 distant metastatic foci (12.50%). A significant difference was also observed in pleural samples (P = 0.005*). Conclusion: We observed more successful results with cell blocks obtained from liquid-based cytological specimens than with formalin-fixed, paraffin-embedded tissues obtained from resection or otherwise in our clinical routine. Our study results highlight the benefits of cytological specimens in molecular treatments and current therapy modalities.

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.

The identification of non-hematopoietic cells in effusions is a diagnostic challenge in cytology. Biopsies from mesothelium or primary lesions are infrequently performed in clinical settings and immunochemistry on smears or immunohistochemistry on cell blocks are the most common ancillary test to refine the cytological diagnosis. Cavitary effusions are an ideal matrix for flow cytometry and the availability of a cytometric panel to describe non-hematopoietic cells would represent a useful tool. Here we present the results of the flow cytometric and immunohistochemical determination of cytokeratin (CK), vimentin (VIM) and desmin (DES) in 36 canine effusions. The concordance between the two methods was perfect for CK (100%), substantial for VIM (77.8%), and almost perfect for DES (97.2%). The panel was interpreted to define the epithelial (CK+VIM-DES-), mesothelial (CK+VIM+DES+), or mesenchymal (CK-VIM+DES-) origin of the cells. Unexpected profiles were considered doubtful and observed patterns were individually discussed. The concordance of the panel interpretation between two methods was 75%. The evaluation of discordant and doubtful cases suggests a lower sensitivity of flow cytometry in detecting VIM expression and revealed a high frequency of VIM+ epithelial cells, variable expression of VIM in mesothelial cells, and an important role of DES in excluding an epithelial origin when positive. Multicentric studies based on histopathological diagnoses are necessary to confirm these findings and evaluate the diagnostic utility of the panel to refine cytological diagnosis. Our results show that flow cytometry can be a timesaving alternative to IHC on cell blocks in clinical settings to detect CK, VIM and DES expression. The interpretation of the panel is similar in most cases; however, occasional discordant results, particularly for VIM, may occur.

Background: Cytological study of pleural fluid helps establishing the underlying cause of pleural effusion. It is considered the most important tool in diagnosing malignancy in effusions. However, accurate identification of cellular morphology can be a problem in conventional cytology. Cell block preparation from pleural effusion aids in this diagnosis due to the preservation of tissue architecture, and multiple sections can be obtained for further studies. Aims and Objectives: The objectives of this study were to compare the diagnostic results of conventional cytology and cell block studies of suspected malignant pleural effusions and find out the diagnostic agreement or concordance between the two methods. Materials and Methods: A record-based study was conducted at the Department of Pathology on conventional cytology and cell block study reports of 150 suspected malignant pleural effusion cases over 35 months. The diagnoses were expressed in five categories – non-diagnostic, negative for malignancy, atypia of undetermined significance, suspicious for malignancy, and malignant. χ2 test was used to identify the percentage of malignancy reported. Agreement of both methods was assessed through Kappa statistics. Results: About 4.67% of cases were reported as malignant by conventional cytology, whereas cell block study diagnosed malignancy in 19.33% of cases. Relative diagnostic agreement between the two methods was 0.73 and concordance by Cohen’s Kappa was 0.34, which signifies fair concordance. Conclusion: Cell block study, though having a fair concordance, is much superior to conventional cytology smears in detecting malignant cells and diagnosing a pleural effusion as malignant.

Background: Cytological study of pleural fluid helps establishing the underlying cause of pleural effusion. It is considered the most important tool in diagnosing malignancy in effusions. However, accurate identification of cellular morphology can be a problem in conventional cytology. Cell block preparation from pleural effusion aids in this diagnosis due to the preservation of tissue architecture, and multiple sections can be obtained for further studies. Aims and Objectives: The objectives of this study were to compare the diagnostic results of conventional cytology and cell block studies of suspected malignant pleural effusions and find out the diagnostic agreement or concordance between the two methods. Materials and Methods: A recordbased study was conducted at the Department of Pathology on conventional cytology and cell block study reports of 150 suspected malignant pleural effusion cases over 35 months. The diagnoses were expressed in five categories -- non-diagnostic, negative for malignancy, atypia of undetermined significance, suspicious for malignancy, and malignant. Χ2 test was used to identify the percentage of malignancy reported. Agreement of both methods was assessed through Kappa statistics. Results: About 4.67% of cases were reported as malignant by conventional cytology, whereas cell block study diagnosed malignancy in 19.33% of cases. Relative diagnostic agreement between the two methods was 0.73 and concordance by Cohen's Kappa was 0.34, which signifies fair concordance. Conclusion: Cell block study, though having a fair concordance, is much superior to conventional cytology smears in detecting malignant cells and diagnosing a pleural effusion as malignant. [ABSTRACT FROM AUTHOR]

Objective: Thoracocentesis is a less invasive and expensive procedure than pleural biopsy, enabling sample collection for cytological evaluation. Cell blocks prepared from these samples provide histopathological diagnoses; further, immunohistochemistry (IHC) can be performed for subtyping malignancies, guiding the clinician in choosing the appropriate treatment modality for the patient. We aimed to determine the various histological subtypes of malignancies using cell block IHC and compare the cell block and conventional cytology methods for diagnosing malignant pleural effusion. Material and Methods: All pleural fluid samples from the clinically suspicious cases of malignancy collected at the Department of Pathology, Government Medical College Kottayam, India, during 18 months, except duplicate and inadequate samples, were included in this prospective observational study. IHC was performed on cell blocks that were positive for malignancy. Results: This study analyzed 630 samples, of which 121 cell blocks demonstrated the presence of malignancy. Overall, 80%, 13%, and 7% of cases were negative, suspicious, and positive for malignancy based on conventional cytology, and 81%, 0%, and 19% were negative, suspicious, and positive for malignancy based on cell blocks, respectively. Among all malignancies, adenocarcinomas from the lung (56%) were the most common, followed by adenocarcinomas from the breast (6%), squamous cell carcinomas (5%), and adenocarcinomas from the ovary (3%). Cell blocks helped detect more malignancies (19%) than conventional cytology (7%), despite a moderate agreement between both methods. Conclusion: Adenocarcinomas were the most common cause of malignant pleural effusions, and the most frequent site of origin was the lungs. Cell blocks helped diagnose more malignancies than conventional cytology. [ABSTRACT FROM AUTHOR]

Introduction: 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. Materials and Methods: 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. Results: 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). Conclusion: 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.

Introduction: 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. Materials and Methods: 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. Results: 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). Conclusion: 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. [ABSTRACT FROM AUTHOR]

Abstract Background/Aims The sensitivities of endoscopic trans‐papillary pathologic diagnosis of biliary tract cancer (BTC) are unsatisfactory. Recently, the diagnostic utility of the endoscopic scraper device, Trefle for biliary stricture has been reported. The Trefle can be guided to the target biliary stricture over the guidewire and is as easy to use as the conventional brush catheter (CBC). This study evaluated the efficacy and safety of Trefle‐assisted tissue acquisition combined cell block method and CBC cytology for biliary strictures due to BTCs. Methods We retrospectively reviewed consecutive patients with biliary strictures in whom CBC cytology or Trefle‐assisted tissue acquisition under endoscopic retrograde cholangiopancreatography was performed for suspected BTCs from January 2015 to June 2022 at our institution. Results 173 patients (CBC group; n = 55, Trefle group; n = 118) were enrolled in this study. The sensitivity, specificity, and accuracy of CBC cytology for BTC were 68.3%/100%/76.4%. On the other hand, the sensitivity, specificity, and accuracy of Trefle‐assisted tissue acquisition for BTC were 93.7%/95.7%/94.1%, showing superior sensitivity (p < 0.001) and accuracy (p = 0.002) compared to that of CBC. Conclusions Compared to CBC cytology, Trefle‐assisted tissue acquisition has superior diagnostic performance while maintaining procedural simplicity and is considered useful for diagnosing malignant biliary stricture.

Thyroid gland, despite being a highly vascular organ, is an extremely unusual site for metastasis from primary carcinoma like breast. We, hereby, report a case of metastatic lesion in the thyroid with breast carcinoma as a primary, in a 55-year-old postmenopausal female. The metastatic focus had masqueraded as nodular goitre, thereby, creating diagnostic difficulty. The case was suspected on Fine Needle Aspiration (FNA) and confirmed by immunocytochemistry on cell block with progesterone and Her2neu positivity. Also, we have attempted to review the literature reporting similar occurrences. Although breast cancer is less frequent to metastasize to thyroid, it is advised to always exclude metastasis from breast carcinoma especially if new thyroid lesions occur in patients with this malignancy. Such cases create diagnostic dilemma on cytology due to morphologic similarities between primary and metastatic thyroid lesions. Cell block is a crucial technique where ancillary techniques like immunocytochemistry can be applied and help in early and timely diagnosis, hence, rendering better prognostic outcome.

Abstract Background Primary thyroid lymphoma (PTL) is a rare cancer accounting for approximately 5% of thyroid malignancies. Historically, incisional biopsy has been the gold standard for definitive diagnosis of PTL, however, the use of cell block as an adjunct to fine needle aspiration (FNA) provides a high sensitivity and specificity for diagnosis and classification. Methods Three patients presented with a symptomatic enlarging thyroid mass. Patient 1 underwent incisional biopsy under general anesthesia, Patient 2 underwent core needle biopsy to avoid high risk intubation, and Patient 3 underwent fine needle aspiration alone with the use of cell block. Results All patients were diagnosed with a fully classified non-Hodgkin’s lymphoma using immunohistochemistry, flow cytometry, and fluorescence in situ hybridization (FISH) analysis. Conclusions FNA for diagnosis of some subtypes of PTL is feasible and preferred in cases that are particularly high risk for general anesthesia. This minimally invasive technique is safe and cost effective as it avoids expenses associated with operative intervention.

Background: 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. Materials and Methods: 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). Results: 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. Conclusion: 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. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of endobronchial (EBUS) and endoscopic ultrasound (EUS) in cytomorphological verification of a malignant process using the transbronchial needle aspiration (TBNA) of the lymph nodes and mediastinal organs.Materials and methods: In 2017–2019 we analyzed the cytological samples (standard and cell block) of 172 patients (115 males and 57 females) with an average age of 61 years (25–82 years) in the clinical diagnostic laboratory of Scientific Research Institute – Ochapovsky Regional Clinical Hospital No. 1 (Krasnodar, Russian Federation). Of them 111 were used for immunocytochemical analysis. The majority of the studies (77) were performed in patients with lung cancer in order to identify the stage of the disease. We used combined bronchoscopy under general anesthesia in the operating room with high-frequency ventilation and a rapid on-site evaluation (ROSE).Results: We found the lymph node and mediastinal invasion in 140 (81%) patients who underwent EBUS-EUS TBNA. The non-diagnostic results were obtained in 32 (19%) patients. The combination of EUS and EBUS with TBNA showed the highest effectiveness in the mentioned clinical cases. The sensitivity, specificity, and accuracy of the cytologic analysis during EBUS and EUS with TBNA and no ROSE were 89%, 100%, and 90%, respectively. ROSE reduced the rate of non-diagnostic results and increased the sensitivity (96%), specificity (100%), and accuracy (97%) of the cytologic evaluation.Conclusions: According to the obtained results, we recommend using EBUS-EUS TBNA modalities for morphological verification of the mediastinal lymph nodes as a routine invasive diagnosis component of the preoperative evaluation in patients with lung cancer.

Abstract Background Targeted sequencing of cytologic samples has significantly increased in recent years. With increasing numbers of clinical trials for variant specific therapeutics, validating a comprehensive assay for cytologic samples has become clinically important. Aim For this study, a retrospective review of cytologic cell blocks from fine needle aspirations and fluid specimens was performed. Methods Two hundred twenty six total cases of solid tumor malignancies were identified, of which 120 cases and 20 lymph node negative controls were sequenced for the Oncomine Comprehensive Assay. Cytology and surgical specimen correlation was performed in a subset of cases. Statistical analysis to determine variant concordance was performed. Results Within the 117 cases sequenced, a total of 347 pathogenic variants were detected. Of the 117 cases, 32 cases (27.4%) would qualify for FDA approved targeted therapy according to the current guidelines, and an additional 23 cases (19.7%) would qualify for clinical trial based on pathogenic variants detected. Discussion With over 27% of cases in our cohort qualifying for some form of targeted therapy, our study shows the importance of providing comprehensive molecular diagnostic options. Despite only half of the cytology cases in the review period having enough material to be sequenced, overall approximately 27% of patients in this cohort would have benefitted from this service.

Thyroid gland, despite being a highly vascular organ, is an extremely unusual site for metastasis from primary carcinoma like breast. We, hereby, report a case of metastatic lesion in the thyroid with breast carcinoma as a primary, in a 55-year-old postmenopausal female. The metastatic focus had masqueraded as nodular goitre, thereby, creating diagnostic difficulty. The case was suspected on Fine Needle Aspiration (FNA) and confirmed by immunocytochemistry on cell block with progesterone and Her2neu positivity. Also, we have attempted to review the literature reporting similar occurrences. Although breast cancer is less frequent to metastasize to thyroid, it is advised to always exclude metastasis from breast carcinoma especially if new thyroid lesions occur in patients with this malignancy. Such cases create diagnostic dilemma on cytology due to morphologic similarities between primary and metastatic thyroid lesions. Cell block is a crucial technique where ancillary techniques like immunocytochemistry can be applied and help in early and timely diagnosis, hence, rendering better prognostic outcome. [ABSTRACT FROM AUTHOR]

Objectives: Carcinosarcomas (CSs) are rare gynecological neoplasms seen in elderly females. These are composed of malignant epithelial and mesenchymal components, which appear as adenocarcinoma and high-grade sarcoma. Effusions are encountered uncommonly in CS. Material and Methods: The study focuses on the cytomorphology of 10 cases of metastatic CS in effusions. In 6 years, there were 10 (0.45%) cases of metastatic CS in effusion samples out of 2240 malignant effusion samples. The samples were processed by SurePath™ and centrifuge technique. Both May--Grünwald--Giemsa and Papanicolaou stained smears were evaluated for cytomorphological features, and the findings were correlated with subsequent histopathology. Results: The cells were predominantly arranged in ball-like clusters and discretely. The cells had abundant vacuolated cytoplasm and enlarged pleomorphic nuclei. Occasional cases showed scattered spindle cells. The cases were diagnosed as metastatic adenocarcinoma (7/10) and positive for malignant cells (3/10). None of the cases was diagnosed as CS. The primary of these cases was in the uterus (7/10) and ovary (3/10). Conclusion: The cytological evaluation of such effusion samples rarely demonstrates the classical biphasic pattern of these tumors. Mostly, the carcinomatous component is evident, and the sarcomatous element is inapparent and readily missed. [ABSTRACT FROM AUTHOR]

Background: Primary thyroid lymphoma (PTL) is a rare cancer accounting for approximately 5% of thyroid malignancies. Historically, incisional biopsy has been the gold standard for definitive diagnosis of PTL, however, the use of cell block as an adjunct to fine needle aspiration (FNA) provides a high sensitivity and specificity for diagnosis and classification. Methods: Three patients presented with a symptomatic enlarging thyroid mass. Patient 1 underwent incisional biopsy under general anesthesia, Patient 2 underwent core needle biopsy to avoid high risk intubation, and Patient 3 underwent fine needle aspiration alone with the use of cell block. Results: All patients were diagnosed with a fully classified non-Hodgkin's lymphoma using immunohistochemistry, flow cytometry, and fluorescence in situ hybridization (FISH) analysis. Conclusions: FNA for diagnosis of some subtypes of PTL is feasible and preferred in cases that are particularly high risk for general anesthesia. This minimally invasive technique is safe and cost effective as it avoids expenses associated with operative intervention. [ABSTRACT FROM AUTHOR]

Background: Melanoma is an aggressive malignant tumor with high metastatic potential. FNAC provides a quick and effective tool to diagnose primary and metastatic melanoma cases. Aims and Objectives: To document the epidemiological features of malignant melanoma cases attending in a tertiary care centre in India, with special reference to different cytomorphological parameters. Materials and Methods: This was a retrospective hospital based study done in the Department of Pathology. 39 cases of malignant melanoma diagnosed on cytology during a period of 3 years were retrieved, reviewed and studied. Results: Out of the 39 cases,21 were males(1.16 male:female ratio).The mean age was 53 years. Metastatic cases were more common than primary melanoma cases. Most common site for metastasis was liver followed by inguinal lymph node. Epitheloid was the most common pattern. Conclusion: Characterstic melanin pigment although common , is not always present. Thus, cytopathologists must know the various cytomorphological spectrum of features of melanoma. [ABSTRACT FROM AUTHOR]

Background: 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. Materials and Methods: 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). Results: 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. Conclusion: 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.

Background: Fluid cytology plays an important role in delineating benign from malignant effusions, tumor staging, and also in diagnosing recurrences. Various methods are used in cytology for the preparation of smears. As the accurate diagnosis of the fluids aids in clinical decisions, the method of preparation of cytology smears, it is very important. Cytospin preparation of smears is one of the methods which provide higher cellular yield with better preservation of cellular morphology and is less time consuming. On the other hand, cell block method gives superior architectural details and provides options for immunocytochemistry. Aims and Objectives: The aim of this study was to assess the diagnostic utility of cytospin in comparison to cell block method in peritoneal and pleural fluid cytology. The study is done to determine the sensitivity, specificity, predictive values, and diagnostic accuracy of cytospin preparations with cell block method which is considered as the gold standard. Materials and Methods: This was a diagnostic test evaluation study done at the Department of Pathology, Government Medical College, Kottayam. The sample size was 240 which included all pleural and peritoneal fluids received in our cytology laboratory during the study period. Cytospin prepared smears of peritoneal and pleural fluids were compared with the tissue sections prepared by cell block method, to evaluate the diagnostic utility of cytospin. Tissue sections prepared from the cell blocks of effusions were considered as the gold standard for comparison. Results: A diagnostic test evaluation of cytospin preparation was done with cell block preparations. The sensitivity of cytopsin preparations in pleural and peritoneal fluid cytology is 94%. The specificity of cytopsin preparations in pleural and peritoneal fluid cytology is 100%. The positive predictive value of cytopsin preparations in pleural and peritoneal fluid cytology is 100% and the negative predictive value of cytopsin preparations in pleural and peritoneal fluid cytology is 96.8%. Hence, accuracy of the test is 97.9%. Conclusion: There is only minimal statistical difference between the results obtained by the cytospin and cell block methods. Cytospin method is less time consuming along with the advantage of higher cellular yield. Hence, the incorporation of cytospin along with the cell block technique is beneficial for augmenting the results of effusion cytology.

Abstract Background Lung cancer is the main cause of cancer‐related death worldwide, and 85% of all lung tumors are non‐small cell lung cancers (NSCLC). More than 60% of all lung tumors are diagnosed at an advanced stage, leading to poor prognosis. Given the growing demand for NSCLC profiling for selection of the most appropriate therapy, the acquisition of adequate tumor samples has become increasingly crucial, mostly in advanced NSCLC patients due to old age and/or comorbidities. Being a mini‐invasive sampling technique, endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) represents a valuable alternative to traditional transthoracic or surgical sampling in these patients, and perfoming cell block (CB) could be crucial to maximize the potential biological information. The aim of this study is to describe a monoinstitutional interprofessional experience in handling EBUS‐TBNA and CB in 464 patients. METHODS We retrospectively collected all the consecutive CBs obtained from EBUS TBNA performed between 2014 and 2021 on the lung lesions or mediastinal lymph nodes. All the CBs were handled in a standardized method. RESULTS A total of 95.5% (448/464 samples) of adequacy for site and 92.6% (430/464) of adequacy for diagnosis were observed. Moreover, in the adenocarcinoma histotype, ALK, ROS1 and tumor proportion score (TPS) PD‐L1 assessment by IHC was possible in 96% (140/146) of cases, and molecular profile was obtained in 93.8% (137/146) of cases. In the squamous cell carcinoma histotype, TPS PD‐L1 assessment was possible in 81% (13/16) of cases. All four CB results obtained from carcinoma NOS were adequate for ALK, ROS1 and PD‐L1 assessment and molecular profiling. All 39 metastatic samples from extra‐pulmonary primary were adequate for immunohistochemical characterization and molecular profiling. Finally, reporting of the tumor sample adequacy to the clinicians took a median time of about 30 h (range: 24–80 h). Conclusion Careful cytological smear management together with the handling and standardization of CB obtained from EBUS‐TBNA could represent an effective method to increase the adequacy of the tumor specimen for both diagnosis and molecular profile.

Background: Targeted sequencing of cytologic samples has significantly increased in recent years. With increasing numbers of clinical trials for variant specific therapeutics, validating a comprehensive assay for cytologic samples has become clinically important. Aim: For this study, a retrospective review of cytologic cell blocks from fine needle aspirations and fluid specimens was performed. Methods: Two hundred twenty six total cases of solid tumor malignancies were identified, of which 120 cases and 20 lymph node negative controls were sequenced for the Oncomine Comprehensive Assay. Cytology and surgical specimen correlation was performed in a subset of cases. Statistical analysis to determine variant concordance was performed. Results: Within the 117 cases sequenced, a total of 347 pathogenic variants were detected. Of the 117 cases, 32 cases (27.4%) would qualify for FDA approved targeted therapy according to the current guidelines, and an additional 23 cases (19.7%) would qualify for clinical trial based on pathogenic variants detected. Discussion: With over 27% of cases in our cohort qualifying for some form of targeted therapy, our study shows the importance of providing comprehensive molecular diagnostic options. Despite only half of the cytology cases in the review period having enough material to be sequenced, overall approximately 27% of patients in this cohort would have benefitted from this service. [ABSTRACT FROM AUTHOR]

Background: White Sponge Nevus (WSN) is a rare benign disorder associated with mutations in genes coding for cytokeratin 4 (KRT4) and 13 (KRT13) characterized by dyskeratotic hyperplasia of mucous membranes. This study was aimed at examining different approaches (cytology, pathology and genetic analysis) to WSN diagnosis. Methods: A series of four patients with asymptomatic white diffuse oral lesions were evaluated and, before performing an incisional biopsy for pathology, an oral brush Thin Prep was collected for exfoliative liquid-based cytology (LBC). DNA for genetic analysis was also obtained from patients and both their parents, using buccal swabs. Results: Pathology and cytology showed similar results, leading to the same diagnosis of hyperkeratotic epithelium with acanthosis and spongiosis, without atypia, demonstrating the efficiency of LBC for the differential diagnosis. Sequencing analysis revealed at least 6 rare variants in the KRT4 and KRT13 genes in each patient, contributed in part by both unaffected parents. Conclusions: Thin Prep for oral exfoliative cytology and genetic analysis are sufficient for an accurate diagnosis of WSN. The combination of cytological and genetic analyses could substitute the histologic exam, providing a non-invasive alternative for incisional biopsy. [ABSTRACT FROM AUTHOR]

A 12-year-old boy presented with abdominal distention for 1 year. On examination, he had massive hepatomegaly. Facial swelling in the maxillary region, palpable left cervical lymph nodes, and a nasal twang to his voice were detected. Imaging showed multiple hypodense liver lesions, necrotic mediastinal and hilar lymph nodes, multiple lytic–sclerotic skeletal lesions, and lesions in the nasopharynx and maxilla. Fine needle aspirate (FNA) from the cervical lymph node yielded blood. FNA from the liver showed singly dispersed and cohesive clusters of tumor cells, with interspersed neutrophils and tingible body macrophages. Cells had scant to moderate fragile cytoplasm, enlarged vesicular nuclei, and prominent nucleoli. Immunohistochemistry on cell block revealed positivity for cytokeratin and Epstein–Barr virus (EBV)-Latent Membrane Protein-1 (LMP1). A diagnosis of metastatic nasopharyngeal carcinoma was made, and was confirmed on a subsequent biopsy from the femur.

A 12-year-old boy presented with abdominal distention for 1 year. On examination, he had massive hepatomegaly. Facial swelling in the maxillary region, palpable left cervical lymph nodes, and a nasal twang to his voice were detected. Imaging showed multiple hypodense liver lesions, necrotic mediastinal and hilar lymph nodes, multiple lytic–sclerotic skeletal lesions, and lesions in the nasopharynx and maxilla. Fine needle aspirate (FNA) from the cervical lymph node yielded blood. FNA from the liver showed singly dispersed and cohesive clusters of tumor cells, with interspersed neutrophils and tingible body macrophages. Cells had scant to moderate fragile cytoplasm, enlarged vesicular nuclei, and prominent nucleoli. Immunohistochemistry on cell block revealed positivity for cytokeratin and Epstein–Barr virus (EBV)-Latent Membrane Protein-1 (LMP1). A diagnosis of metastatic nasopharyngeal carcinoma was made, and was confirmed on a subsequent biopsy from the femur. [ABSTRACT FROM AUTHOR]

Background: Cell block preparation is routine practice in cytopathology these days because of its pivotal role in increasing diagnostic yield and ancillary studies. In the present era of personalized medicine in oncology, ancillary techniques such as immunohistochemistry (IHC) and molecular analysis are gaining more importance. Methods: A retrospective study was conducted in the Department of Pathology, over 6 months, which included 144 cases of Fine Needle Aspiration Cytology (FNAC) of abdominopelvic masses and 105 cases of ascitic fluids. Cell blocks and conventional smears were prepared simultaneously in all cases. IHC was applied on cell blocks and analyzed. Results: IHC was performed on cell blocks in 76 cases of FNA and 53 cases of ascitic fluids. Based on IHC, liver lesions (50 cases) were categorized into metastatic carcinomas with a suggested primary site (45.0%), hepatocellular carcinoma (12.2%), neuroendocrine tumors (16.3%), and malignant melanoma (2%). Using MOC-31 and WT-1, ascitic fluid samples were categorized into benign and malignant. Forty-one out of 53 cases of fluids were diagnosed as metastatic adenocarcinomas with the ovary as the most common primary site. Conclusion: A panel of IHC markers, though not specific alone when applied to cell blocks in a careful clinical and morphological context leads to a rapid and accurate diagnosis. This in turn obviates the need for biopsy in severely ill patients. An astute pathologist can provide accurate results with judicious use of IHC on cell blocks and may bring a sigh of relief for many cancer patients by averting the need for biopsy. [ABSTRACT FROM AUTHOR]

Background: Fluid cytology plays an important role in delineating benign from malignant effusions, tumor staging, and also in diagnosing recurrences. Various methods are used in cytology for the preparation of smears. As the accurate diagnosis of the fluids aids in clinical decisions, the method of preparation of cytology smears, it is very important. Cytospin preparation of smears is one of the methods which provide higher cellular yield with better preservation of cellular morphology and is less time consuming. On the other hand, cell block method gives superior architectural details and provides options for immunocytochemistry. Aims and Objectives: The aim of this study was to assess the diagnostic utility of cytospin in comparison to cell block method in peritoneal and pleural fluid cytology. The study is done to determine the sensitivity, specificity, predictive values, and diagnostic accuracy of cytospin preparations with cell block method which is considered as the gold standard. Materials and Methods: This was a diagnostic test evaluation study done at the Department of Pathology, Government Medical College, Kottayam. The sample size was 240 which included all pleural and peritoneal fluids received in our cytology laboratory during the study period. Cytospin prepared smears of peritoneal and pleural fluids were compared with the tissue sections prepared by cell block method, to evaluate the diagnostic utility of cytospin. Tissue sections prepared from the cell blocks of effusions were considered as the gold standard for comparison. Results: A diagnostic test evaluation of cytospin preparation was done with cell block preparations. The sensitivity of cytopsin preparations in pleural and peritoneal fluid cytology is 94%. The specificity of cytopsin preparations in pleural and peritoneal fluid cytology is 100%. The positive predictive value of cytopsin preparations in pleural and peritoneal fluid cytology is 100% and the negative predictive value of cytopsin preparations in pleural and peritoneal fluid cytology is 96.8%. Hence, accuracy of the test is 97.9%. Conclusion: There is only minimal statistical difference between the results obtained by the cytospin and cell block methods. Cytospin method is less time consuming along with the advantage of higher cellular yield. Hence, the incorporation of cytospin along with the cell block technique is beneficial for augmenting the results of effusion cytology. [ABSTRACT FROM AUTHOR]

Background: Cytological smear and cell block are commonly used to diagnose pleural fluid effusion. However, there is a paucity of information in the literature where a comparison between a cytological smear and a cell block with corresponding pleural biopsy has been done. This study aimed to evaluate the accuracy of cytological smears, cell blocks, and pleural biopsy for the diagnosis of malignant tumors. Material and Methods: In this cross-sectional study, analysis of successive pleural fluid samples received by the department was done. The sample was divided into equal halves of 5 ml each. One was used for conventional smear and the second was used for the preparation of cell block. The cell block was prepared by centrifuging the specimen of fluid at 2500 rpm for 15 min. A pleural biopsy was obtained by using Cope's pleural biopsy needle. Results: A total of n = 50 cases were included in the study. A total of n = 8 cases were diagnosed as malignant by cell smear and n = 4 cases were suspicious for malignancy. By cell block, n = 10 cases of malignancy were diagnosed and n = 1 case was suspicious for malignancy. By biopsy, n = 11 cases were diagnosed as malignant and n = 1 case was suspicious for malignancy. Out of the total, n = 2 cases were diagnosed as squamous cell carcinoma by biopsy; one case was diagnosed by cell block; and the other was reported as suspicious for malignancy. Conclusion: The study shows that cell blocks are complementary to the cell smear technique in over diagnosis and categorization of benign as well as malignant cells. The cell blocks were more useful in the diagnosis of malignancy because of better preserved architectural patterns as seen in corresponding histopathology sections. It, therefore, appears that the cell blocks are a perfect fit to bridge the cytology and histopathology.

Introduction: Cervical lymphadenopathy is a common clinical presentation in various departments of clinical practice. Fine needle aspiration cytology (FNAC) is usually the first choice to diagnose superficial cervical lymphadenopathy. However, FNAC sometimes does not yield information for precise diagnosis, and the risk of false-negative and indeterminate diagnosis is always present. In order to overcome these problems, cell block technique has been resorted to make the best use of the available material. Objective: The aim of this article is to evaluate whether there are any diagnostic advantages of cell block histopathology over conventional smear cytology by corroborating with excisional biopsy. Materials and Methods: A descriptive study with cross-sectional design was performed among 106 cases with clinical suspicion of malignancy. FNAC was performed without anesthesia, and the aspirated material was flushed on slides and then fixed immediately. The remaining materials were processed into cell blocks followed by HE staining. The data obtained were analyzed using SPSS (IBM Statistics, Version 20.0, SPSS, Chicago, IL, USA) statistical software. Ethical approval was obtained from the Institutional Ethics Committee, and informed consent was taken from all the participants before the procedure. Results: Out of the 106 cases, 101 (95.28%) cases were diagnosed as malignant lesions and 5 (4.72%) cases diagnosed as non-malignant lesions. The majority of the patients were in the 40–59 year age group and were males. The sensitivity of cytology to provide specific diagnosis in malignant lesions was 90.57%, whereas those of cell block histopathology and cell block histopathology with cytology were 94.34% and 98.11%, respectively. Conclusion: Cell block as an adjunct to FNAC can be a useful diagnostic technique in cervical lymphadenopathy. Compared with FNAC, it gives more accurate diagnostic architecture and apparent histopathological features.

Introduction: Cytological samples obtained by endobronchial ultrasound (EBUS) are capital for diagnosis, staging and molecular profile in non-small cell lung carcinoma (NSCLC). Objective: To assess the success rate of complete, partial and individual of molecular analysis in samples obtained by EBUS-guided transbronchial needle aspiration (TBNA) and/or by oesophageal ultrasound-guided fine needle aspiration with an echobronchoscope (EUS-B-FNA) in patients with NSCLC. Methods: Prospective study including 90 patients with non-squamous NSCLC, or non-smoking squamous. Cytological samples were classified into two groups. Group 1: PEN membrane slide and/or cell blocks for the determination of mutations of EGFR, KRAS, ERBB2 and BRAF. Group 2: silane coated slides or cell blocks for rearrangements of ALK, ROS1 and MET amplification. Results: The success rate was 78.6% for 4 molecular alterations (EGFR, KRAS, ALK and ROS1), and 44% for 7 determinations. The individual success rate for EGFR was 97%, KRAS 96.3%, ALK 85%, ROS1 82.3%, ERBB2 71.4%, BRAF 67.7% and MET 81.1%. There were no significant differences (p = 0.489) in the number of molecular analyses (1–3 vs. 4) in group 1, depending on the types of samples (cell block vs. PEN membrane slide vs. cell block and PEN membrane slide). Conclusions: In patients with NSCLC, the cytological material obtained by ultrasound-guided needle aspiration is sufficient for individual and partial molecular analysis in the vast majority of cases. Membrane slides such as cell blocks are valid samples for molecular analysis.

Context: Fine-needle aspiration cytology is considered the gold standard screening test in the evaluation of a thyroid nodule. We studied whether cell block cytology can be used in addition to conventional smears for the evaluation of tissue from fine-needle aspirations or fluid aspirations and also compared it with histopathological diagnosis. Aims: The primary aim of this study was to know the utility of cell blocks in the diagnosis of thyroid lesions. Settings and Design: This was a prospective observational study conducted from June 2018 to September 2020 at a tertiary Care Hospital in Eastern India. Ethical approval was obtained from the Ethics Committee of the institution. Patients above 18 years who presented with goiter were included in the study. Thirty patients were enrolled in the study after informed consent. Methods and Material: Smears prepared from the aspirates were stained with Leishman-Giemsa (LG) and Pap stain. The remnant from the needle hub was transferred to a sterile container. Cell blocks were prepared from the remnants. Smears were scored based on cell obscuration by blood, cellularity, cell degeneration, and cell architecture. The results were compared with histopathology. Statistical Analysis Used: Data were recorded using Microsoft Excel. Descriptive statistics, frequency, and proportion were used to describe demographic variables. Results: The majority of the patients (23.3%) were in their third decade of life, followed by 16.7% of the patients in their fourth and fifth decades. The patient age ranged from 25 to 80 years, with a mean age of 50.83 years and a standard deviation of 16.72. The largest number of patients were females accounting for 80% (24/30) of the total participants. The majority of the patients (36.7%) (11/30) had thyroid gland enlargement for a period of 15 days to three months. 14% of the participants were not able to recall its duration. The majority (60%) (18/30) had left lobe lesions, followed by 33.3% (10/30) who had right lobe lesions, and 6.7% (2/30) who had bilateral lobe swelling. The mean size of the lesion was 2.84 cm. 50% were found to be Bethesda II lesions, while 13.3% were Bethesda IV, and 36.7% were found to be Bethesda VI lesions. The cell block score (7) was found to be better compared to Fine Needle Aspiration Cytology (FNAC) (4.7). Tissue Coagulum Clot and Clot Scrape methods were found to yield better results compared to the Cytocentrifuge method. The P value was found to be significant (

Non-small cell lung cancer is still diagnosed at a late disease stage and systematic therapy is necessary. Currently we have three main treatment modalities; chemotherapy, targeted with tyrosine kinase inhibitors and immune check point inhibitors. In the recent years and based on new studies we can administer combination of chemotherapy and immunotherapy, or radiotherapy and immunotherapy. Every treatment approach is based on the specific gene expression of the tumor. Tyrosine kinase inhibitors have been used for more than a decade for epidermal growth factor positive tumors, the same for anaplastic lymphoma kinase and proto-oncogene 1. Programmed death-ligand 1 expression has been found to be associated with the efficiency of immune checkpoint inhibitors. However; there are still several subpopulations in non-small cell lung cancer patients. We will comment on the group with KRAS G12C mutation and the targeted therapy with sotorasib for its efficiency and toxicity based on new studies.

OBJECTIVE: To compare the findings of cell blocks and smear examination with fine needle aspirates (FNA) in the diagnosis of superficial palpable head and neck lesions taking histopathology as the gold standard. METHODS: This cross-sectional comparative study was conducted at Pakistan Institute of Medical Sciences, Islamabad and Institute of Basic Medical Sciences, Khyber Medical University, Peshawar. Eighty patients of all age groups, having superficial clinically palpable lesions of head and neck region were recruited in the study from August 2014 to August 2015. FNA cytology, cell block and open biopsy were performed in all cases and compared with the histopathological examination. The data was recorded in a proforma and analyzed through SPSS Version-23. RESULTS: Out of 80 patients, 44 (55%) were males and 36 (45%) females. The age of patients ranged from 01-81 years with a mean age of 45.68±20.43 years. Lesions involving lymph nodes (n=31; 38.8%) and salivary gland (n=24; 30%) were common in head and neck region. Tuberculosis (n=15: 48.38%) and pleomorphic adenoma (n=13; 54.16%) were the common lesions involving lymph nodes and salivary glands respectively. Overall, 49 (61.2%) cases were benign/reactive and 31 (38.8%) cases were malignant on histopathology. Sensitivity, specificity, positive predictive value and negative predictive value was 74.2%, 95.9%, 92% & 85.5% for FNA smears and 83.9%, 98%, 96.3% and 90.6% for Cell Block respectively in diagnosing head and neck lesions. CONCLUSION: Cell block with better diagnostic accuracy can be used as adjunct to FNA smears in diagnosis of superficial palpable head and neck lesions.

Background: Cytological smear and cell block are commonly used to diagnose pleural fluid effusion. However, there is a paucity of information in the literature where a comparison between a cytological smear and a cell block with corresponding pleural biopsy has been done. This study aimed to evaluate the accuracy of cytological smears, cell blocks, and pleural biopsy for the diagnosis of malignant tumors. Material and Methods: In this cross-sectional study, analysis of successive pleural fluid samples received by the department was done. The sample was divided into equal halves of 5 ml each. One was used for conventional smear and the second was used for the preparation of cell block. The cell block was prepared by centrifuging the specimen of fluid at 2500 rpm for 15 min. A pleural biopsy was obtained by using Cope's pleural biopsy needle. Results: A total of n = 50 cases were included in the study. A total of n = 8 cases were diagnosed as malignant by cell smear and n = 4 cases were suspicious for malignancy. By cell block, n = 10 cases of malignancy were diagnosed and n = 1 case was suspicious for malignancy. By biopsy, n = 11 cases were diagnosed as malignant and n = 1 case was suspicious for malignancy. Out of the total, n = 2 cases were diagnosed as squamous cell carcinoma by biopsy; one case was diagnosed by cell block; and the other was reported as suspicious for malignancy. Conclusion: The study shows that cell blocks are complementary to the cell smear technique in over diagnosis and categorization of benign as well as malignant cells. The cell blocks were more useful in the diagnosis of malignancy because of better preserved architectural patterns as seen in corresponding histopathology sections. It, therefore, appears that the cell blocks are a perfect fit to bridge the cytology and histopathology. [ABSTRACT FROM AUTHOR]

Simple Summary: Brush cytology remains the primary method used worldwide for diagnosing malignant biliary strictures, despite its low sensitivity. Although the endoscopic scraper, the simplicity of which is comparable to that of a conventional brush, has been used mainly in Japan, it has yet to gain popularity on a global scale. The purpose of this study was to evaluate the diagnostic performance of the endoscopic scraper by comparing diagnostic yields and the number of collected cells using quantitative digital image analysis. Our study revealed that the endoscopic scraper and cell block method achieved higher sensitivity than the brush with the cell block method, and showed that the number of cells on the cell block sections obtained by the endoscopic scraper were significantly higher than those obtained using the brush. Given its ease of use and high sample acquisition capability, the endoscopic scraper could replace brush cytology for diagnosing malignant biliary strictures. Histological evidence is essential for diagnosing malignant biliary strictures. However, conventional brush cytology remains the primary method used worldwide, despite its low diagnostic sensitivity and accuracy, as it is technically easy, rapid, and cost-effective. The aim of this study was to evaluate the diagnostic performance of a recently introduced endoscopic scraper, the simplicity of which is comparable to that of a conventional brush, by comparing diagnostic yields and the number of collected cells. The sensitivity of the endoscopic scraper when using the cell block technique was significantly higher than when using brush cytology or a brush with the cell block technique (53.6% vs. 30.9%, p < 0.001; 53.6% vs. 31.6%, p = 0.024, respectively). Quantitative digital image analysis of cell block sections revealed that the median number of cells obtained with the endoscopic scraper was significantly higher than when using the brush (1917 vs. 1014 cells, p = 0.042). Furthermore, seven cases (8.3%; 7/84) were diagnosed by immunohistochemical analysis of the cell block section obtained from the endoscopic scraper. Given its simplicity and greater capacity for sample acquisition, use of the endoscopic scraper in conjunction with the cell block technique could replace brush cytology for the histological diagnosis of malignant biliary strictures. [ABSTRACT FROM AUTHOR]

Background: Lung cancer is the main cause of cancer‐related death worldwide, and 85% of all lung tumors are non‐small cell lung cancers (NSCLC). More than 60% of all lung tumors are diagnosed at an advanced stage, leading to poor prognosis. Given the growing demand for NSCLC profiling for selection of the most appropriate therapy, the acquisition of adequate tumor samples has become increasingly crucial, mostly in advanced NSCLC patients due to old age and/or comorbidities. Being a mini‐invasive sampling technique, endobronchial ultrasound‐guided transbronchial needle aspiration (EBUS‐TBNA) represents a valuable alternative to traditional transthoracic or surgical sampling in these patients, and perfoming cell block (CB) could be crucial to maximize the potential biological information. The aim of this study is to describe a monoinstitutional interprofessional experience in handling EBUS‐TBNA and CB in 464 patients. METHODS: We retrospectively collected all the consecutive CBs obtained from EBUS TBNA performed between 2014 and 2021 on the lung lesions or mediastinal lymph nodes. All the CBs were handled in a standardized method. RESULTS: A total of 95.5% (448/464 samples) of adequacy for site and 92.6% (430/464) of adequacy for diagnosis were observed. Moreover, in the adenocarcinoma histotype, ALK, ROS1 and tumor proportion score (TPS) PD‐L1 assessment by IHC was possible in 96% (140/146) of cases, and molecular profile was obtained in 93.8% (137/146) of cases. In the squamous cell carcinoma histotype, TPS PD‐L1 assessment was possible in 81% (13/16) of cases. All four CB results obtained from carcinoma NOS were adequate for ALK, ROS1 and PD‐L1 assessment and molecular profiling. All 39 metastatic samples from extra‐pulmonary primary were adequate for immunohistochemical characterization and molecular profiling. Finally, reporting of the tumor sample adequacy to the clinicians took a median time of about 30 h (range: 24–80 h). Conclusion: Careful cytological smear management together with the handling and standardization of CB obtained from EBUS‐TBNA could represent an effective method to increase the adequacy of the tumor specimen for both diagnosis and molecular profile. [ABSTRACT FROM AUTHOR]

Malignant pericardial mesothelioma (MPM) is a rare tumour that arises from the mesothelial cells of the pericardium. No standard treatment has been established owing to a poor treatment response; therefore, MPM has a poor prognosis. We herein report a rare case of MPM in a 70‐year‐old man that was diagnosed immunohistopathologically using cell block sections of pericardial fluid and in which long‐term survival for more than 3 years was achieved with only periodic pericardial drainage. Immunohistopathological staining investigations, especially BRCA1‐associated protein 1 (BAP1) immunostaining using cell block sections of pericardial effusion, are effective in making a diagnosis of MPM. Well‐differentiated papillary mesothelioma (WDPM) with BAP1 loss progresses to MPM in the long term, showing that BAP1 loss may induce phenotypical evolution of WDPM. BAP1 loss may also progress to malignant mesothelioma in situ and then to invasive mesothelioma. BAP1 immunohistochemistry should be considered for the early diagnosis of MPM. [ABSTRACT FROM AUTHOR]

Abstract Malignant pericardial mesothelioma (MPM) is a rare tumour that arises from the mesothelial cells of the pericardium. No standard treatment has been established owing to a poor treatment response; therefore, MPM has a poor prognosis. We herein report a rare case of MPM in a 70‐year‐old man that was diagnosed immunohistopathologically using cell block sections of pericardial fluid and in which long‐term survival for more than 3 years was achieved with only periodic pericardial drainage. Immunohistopathological staining investigations, especially BRCA1‐associated protein 1 (BAP1) immunostaining using cell block sections of pericardial effusion, are effective in making a diagnosis of MPM. Well‐differentiated papillary mesothelioma (WDPM) with BAP1 loss progresses to MPM in the long term, showing that BAP1 loss may induce phenotypical evolution of WDPM. BAP1 loss may also progress to malignant mesothelioma in situ and then to invasive mesothelioma. BAP1 immunohistochemistry should be considered for the early diagnosis of MPM.

Fine-needle aspiration cytology is considered the gold standard screening test in the evaluation of a thyroid nodule. We studied whether cell block cytology can be used in addition to conventional smears for the evaluation of tissue from fine-needle aspirations or fluid aspirations and also compared it with histopathological diagnosis. Aims: The primary aim of this study was to know the utility of cell blocks in the diagnosis of thyroid lesions. Settings and Design: This was a prospective observational study conducted from June 2018 to September 2020 at a tertiary Care Hospital in Eastern India. Ethical approval was obtained from the Ethics Committee of the institution. Patients above 18 years who presented with goiter were included in the study. Thirty patients were enrolled in the study after informed consent. Methods and Material: Smears prepared from the aspirates were stained with Leishman-Giemsa (LG) and Pap stain. The remnant from the needle hub was transferred to a sterile container. Cell blocks were prepared from the remnants. Smears were scored based on cell obscuration by blood, cellularity, cell degeneration, and cell architecture. The results were compared with histopathology. Statistical Analysis Used: Data were recorded using Microsoft Excel. Descriptive statistics, frequency, and proportion were used to describe demographic variables. Results: The majority of the patients (23.3%) were in their third decade of life, followed by 16.7% of the patients in their fourth and fifth decades. The patient age ranged from 25 to 80 years, with a mean age of 50.83 years and a standard deviation of 16.72. The largest number of patients were females accounting for 80% (24/30) of the total participants. The majority of the patients (36.7%) (11/30) had thyroid gland enlargement for a period of 15 days to three months. 14% of the participants were not able to recall its duration. The majority (60%) (18/30) had left lobe lesions, followed by 33.3% (10/30) who had right lobe lesions, and 6.7% (2/30) who had bilateral lobe swelling. The mean size of the lesion was 2.84 cm. 50% were found to be Bethesda II lesions, while 13.3% were Bethesda IV, and 36.7% were found to be Bethesda VI lesions. The cell block score (7) was found to be better compared to Fine Needle Aspiration Cytology (FNAC) (4.7). Tissue Coagulum Clot and Clot Scrape methods were found to yield better results compared to the Cytocentrifuge method. The P value was found to be significant (<0.001). Conclusions: Cell blocks were found to improve the cell morphology compared to FNAC alone and can be used as an adjunct to FNAC in the diagnosis of various thyroid lesions. [ABSTRACT FROM AUTHOR]

Simple Summary: Collecting specimens for pathological diagnosis of malignant biliary stricture (MBS) is not easy. This study shows that cell block (CB) of overnight-stored bile is useful for pathological diagnosis of MBS. Cancer detectability using the CB method (62.2%) is superior to that using cytology (37.8%). When the CB method is combined with biopsy, the cancer detectability (75.6%) and accuracy rates (81.4%) are increased. In addition, immunohistochemistry can be applied to the CB method when encountering difficult cases for pathological diagnosis. The CB method utilizing overnight-stored bile can be routinely used for detecting MBS in local hospitals. The specimen collection and subsequent pathological diagnosis of malignant biliary stricture (MBS) are difficult. This study aimed to determine whether the cell block (CB) method using overnight-stored bile is useful in the diagnosis of MBS. This trial was a single-arm prospective study involving a total of 59 patients with suspected MBS. The primary endpoint was cancer detectability and accuracy using the CB method, and a comparison with the detectability and accuracy achieved with bile cytology was made. The immunohistochemical sensitivity for maspin and p53 was also investigated in the CB and surgical specimens. We were able to collect bile from all 59 patients, and 45 of these patients were clinically diagnosed with MBS. The cancer detectability using the CB method (62.2%) was significantly higher than that using cytology (37.8%) (p = 0.0344). When CB was combined with biopsy, the rates of cancer detectability (75.6%) and accuracy (81.4%) increased. In eight patients who received surgical therapy, maspin- and p53-immunohistochemistry was applied to the surgical and CB specimens, and cancer cells in both specimens showed positive cytoplasmic and nuclear staining for maspin and nuclear staining for p53. The CB method is, thus, useful for detecting malignancy (UMIN000034707). [ABSTRACT FROM AUTHOR]

Background & Objective: Liver lesions are difficult to diagnose and to differentiate primary from metastatic carcinoma, while Biopsy has its limitations. Cell block technology is easily accessible with high diagnostic accuracy. Our aim is 1) To find the role of cell block technology as an alternative to biopsy in identifying liver lesions; 2) To find the efficacy of cell block along with immunohistochemistry (IHC) and ancillary studies in differentiating primary from metastatic lesions; 3) To identify the site of origin of metastatic lesions. This is a descriptive study undertaken in two tertiary care hospitals over a period of three years.Methods: Retrospective review of adequate samples from fine needle aspirations from liver lesions under radiological coverage, converted into cell block was done. IHC was applied as needed. Usefulness of cell block preparation was evaluated, and the final diagnosis correlated with the biopsy results.Results: Analysis of 323 cases found sensitivity of 98.75% and positive predictive value of 99% for all lesions. Sensitivity for metastatic carcinomas was slightly more than hepatocellular carcinoma. However, accuracy of cell block results for individual metastatic lesions and site of origin was less. IHC and morphological pattern worked as an important adjunct in the final diagnosis. On the other hand, contribution of viral markers as a supplement in the final work up was ambiguous. Conclusion: High precision of validity results of cell block technology in comparison with biopsy highlights its pivotal role in conjunction with supportive tests for diagnosing and differentiating liver lesions as well as identifying primary sites in liver metastasis.

Abstract Undifferentiated pleomorphic sarcoma (UPS) is a new disease in the World Health Organization's classification of tumors of soft tissue and bone published in 2013. Primary mediastinal UPS is rare, especially with pleural effusion. Herein, we describe the pathological findings of pleural effusion followed by mediastinal UPS, which was initially misdiagnosed as epithelial malignant pleural mesothelioma (MPM). The cytopathological findings of the pleural effusion cell block often contribute to the diagnosis of various malignant tumors. However, these findings may lead to misdiagnosis of highly invasive mediastinal tumors such as UPS. A biopsy for primary mediastinal lesions should be performed because MPM rarely mimics mediastinal tumors with pleural effusion.

Background Cytological examination of serous fluids is an important diagnostic modality. However, accurately distinguishing reactive or malignant changes is diagnostically challenging. Cell block (CB) technique is dependable procedure as it improves the diagnostic accuracy. Advantage of cell block is the potential to make many sections for special stains and other ancillary techniques. Objective To compare the utility of CB technique compared to conventional smear in fluid cytology. Material & Methods The study comprised of analysis of serous effusion samples of pleural, peritoneal and pericardial cavities. All the samples were studied by both conventional smear method and modified cell block technique. Results In the present study, a total of 100 serous effusions were studied by using comparative approach of routine staining methods and modified cell block technique. By using conventional smear method, 84 cases were reported as inflammatory, 16 were diagnosed as malignant. Out of 100 cases of cell block preparation, 76 were inflammatory in nature and 20 cases were found to be malignant in nature. Four cases which were reported as negative for malignancy by conventional smear method were proven malignant on cell block thus increasing the diagnostic yield Conclusion Cell block method of the study of body fluids is simple, rapid and cost effective and increases the diagnostic yield compared to the routine methods. It increases the diagnostic accuracy when used as an adjunct to conventional smears. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the clinical value of epidermal growth factor receptor (EGFR) detection in pleural effusion cell blocks among patients with non-small-cell lung cancer (NSCLC). Methods: From July 2016 to September 2018, EGFR gene mutations in 40 lung tumor tissue samples and pleural fluid samples from NSCLC patients in Jinhua Municipal Central Hospital were assessed by the amplification refractory mutation system method. The EGFR results of the two types of samples were compared using the paired Chi-square test, and the mutation positive rates in EGFR exons 18, 19, 20 and 21 were compared between the two types of specimens using the four-grid Chi-square test. Results: Among the 40 tissue samples and pleural effusion samples, 21 and 18 cases of EGFR mutations were detected, respectively, and the mutation positive rates were 52.5% and 45%, respectively. The κ value of the consistency test of the two specimens was 0.851. There were no significant differences in the mutation positive rates in EGFR exons 18, 19, 20, and 21 between the two types of specimens. Conclusion: The EGFR results of pleural fluid and tissue samples were in good agreement. Therefore, we can use pleural fluid samples to detect EGFR mutations to guide tyrosine kinase inhibitor treatment for NSCLC patients in whom tumor tissue samples cannot be obtained.

Introduction: Cervical lymphadenopathy is a common clinical presentation in various departments of clinical practice. Fine needle aspiration cytology (FNAC) is usually the first choice to diagnose superficial cervical lymphadenopathy. However, FNAC sometimes does not yield information for precise diagnosis, and the risk of false-negative and indeterminate diagnosis is always present. In order to overcome these problems, cell block technique has been resorted to make the best use of the available material. Objective: The aim of this article is to evaluate whether there are any diagnostic advantages of cell block histopathology over conventional smear cytology by corroborating with excisional biopsy. Materials and Methods: A descriptive study with cross-sectional design was performed among 106 cases with clinical suspicion of malignancy. FNAC was performed without anesthesia, and the aspirated material was flushed on slides and then fixed immediately. The remaining materials were processed into cell blocks followed by HE staining. The data obtained were analyzed using SPSS (IBM Statistics, Version 20.0, SPSS, Chicago, IL, USA) statistical software. Ethical approval was obtained from the Institutional Ethics Committee, and informed consent was taken from all the participants before the procedure. Results: Out of the 106 cases, 101 (95.28%) cases were diagnosed as malignant lesions and 5 (4.72%) cases diagnosed as non-malignant lesions. The majority of the patients were in the 40–59 year age group and were males. The sensitivity of cytology to provide specific diagnosis in malignant lesions was 90.57%, whereas those of cell block histopathology and cell block histopathology with cytology were 94.34% and 98.11%, respectively. Conclusion: Cell block as an adjunct to FNAC can be a useful diagnostic technique in cervical lymphadenopathy. Compared with FNAC, it gives more accurate diagnostic architecture and apparent histopathological features. [ABSTRACT FROM AUTHOR]

Aim:This study aims at investigating the concordance of programmed death-ligand 1 (PD-L1) expression in non-small cell cancer tissues that have been sampled using different methods and its relationship with the pathologic parameters of tumors.Methods:PD-L1 expression assays were made on the cell blocks taken using fine needle aspiration, the small tissue samples representing endoscopic biopsy and the large tissue samples representing the resected tumor taken from the tumors of 100 subjects diagnosed with non-small cell lung cancer; their percentage values were evaluated and their groups were determined based on these values.Results:The average difference in expression rates found through different sampling methods was close to 0, and the values of such differences changed mostly in a narrow range. In paired comparisons, a good level of concordance was observed between all the sampling methods. The values were 0.8865 (SE: 0.0306, CI: 0.8264-0.9466) in the comparison of tumor tissue (TT) and small biopsy (SB): 0.8637, (SE: 0.033, CI: 0.7989-0.9285) TT to cell block (CB): 0.8916, (SE: 0.0272, CI: 0.8383-0.9449) SB tissue to the CB.Conclusion:Therefore, it can be concluded that the PD-L1 expression does not differ between the tissues sampled through various methods in non-small cell lung cancers.

Background: Although liquid-based cytology (LBC) has gained popularity among clinical laboratories, it is unclear whether it is equivalent to conventional smears for making a definite diagnosis of papillary thyroid carcinoma (PTC). The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) suggests a definite diagnosis of PTC is preferred when there are at least one of three features (papillary architecture, psammomatous calcifications, and frequent pseudonuclear inclusions) plus other typical cytomorphological findings. This study evaluated whether an additional cell block (CB), prepared from the residual LBC material, could help improve the diagnosis of PTC. Materials and Methods: A total of 62 cases with both ThinPrep LBC and CB preparations and histopathological follow-up of PTC were retrieved between November 2016 and March 2019. The ThinPrep LBC and CB slides were reviewed separately to identify any papillary architecture, psammomatous calcifications, or pseudonuclear inclusions for diagnosing PTC. Results: Among the 51 cases with cytological diagnosis of PTC in the LBC+CB slides, the CB provided additional diagnostic information in 15 cases, which were initially diagnosed as suspicious for PTC based on the LBC slides alone. This information included papillary architecture (n=11), psammomatous calcification (n=1) and pseudonuclear inclusions (n=5). The number of specimens in the 51 cases containing at least one of the three features increased from 42 (LBC) to 51 (LBC+CB). The accuracy for diagnosing PTC increased from 58.1% for LBC alone to 82.3% for the LBC+CB examination. Conclusion: An adjunctive CB preparation may improve the LBC technique for diagnosing PTC.