Comparative Analysis of the Diagnostic Accuracy of Cell Block Technique to Conventional Smears in Minimally Invasive Procedures of Pulmonary Lesions

Saranyaa, S (2015) Comparative Analysis of the Diagnostic Accuracy of Cell Block Technique to Conventional Smears in Minimally Invasive Procedures of Pulmonary Lesions. Masters thesis, Tirunelveli Medical College, Tirunelveli.


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INTRODUCTION: Cell blocks prepared from residual tissues fluids and fine needle aspirations can be useful adjuncts to smears for establishing a more definitive cytopathologic diagnosis. Conventional smear cytology, however carefully prepared, leaves behind residue that is not further investigated but that might contain valuable diagnostic material. The cell block technique employs the retrieval of small tissue fragments from the residual sample which are processed to from a paraffin block. Multiple sections can be obtained from this block. This allows for immunostains and other studies to be performed similar to the paraffin sections produced in histopathology. They can be particularly useful for categorization of tumors on cytology specimens that may not be possible from smears themselves. AIM OF THE STUDY: Preparation of cell blocks from fluids (pleural fluid, bronchial washings) and residual FNAC material. To compare the diagnostic accuracy of cell block technique with conventional smears. To use immunohistochemistry on cell block for subtyping tumors and in cases suspicious for malignancy. METHODS: In this prospective study, 100 samples which include 50 pleural effusion samples, 35 bronchial wash samples and 15 imaging guided FNAC samples were subjected to make both conventional smear and cell block. Cell blocks were made by plasma thromboplastin method. Both the techniques were compared based on the cellularity, architecture, quality and diagnosis. Immunohistochemistry was performed in cell blocks to confirm and subtype malignant tumors. RESULTS: Abundant cellularity was seen in 31% of the cases by cell block and only 10% of the cases had abundant cellularity by conventional smear. Excellent architecture equivalent to histology was seen in 15% of the cases by cell block and this was not seen in conventional smear. By conventional smear, benign, suspicious of malignancy, malignant and non-diagnostic cases were 66%, 8%, 15%, 11% respectively. By cell block 71% benign, 24% malignant, 5% non-diagnostic. Combining both conventional smear and cell block, the diagnostic yield of malignancy increased by 9%. Immunohistochemistry was performed in 18% of the cases to confirm and subtype the malignancy. CONCLUSION: Cell block is a very good adjunct to conventional smear study in the better yield of cellularity and architecture with an advantage to do immunohistochemistry, leading to better diagnosis of malignancy in the fluids and residual FNAC samples of pulmonary lesions. Ideally cell block technique should be used in routine practice for cytological diagnosis.

Item Type: Thesis (Masters)
Uncontrolled Keywords: conventional smear ; cell block ; immunohistochemistry.
Subjects: MEDICAL > Pathology
Depositing User: Punitha K
Date Deposited: 19 May 2018 15:15
Last Modified: 23 May 2018 02:02

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