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      Role of cell block in cytopathologic evaluation of image-guided fine needle aspiration cytology

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          Abstract

          Context:

          Fine needle aspiration cytology (FNAC) of superficial or deep-seated lesion is an increasingly common practice, eliminating time consuming and costly diagnostic procedures and providing rapid and safe diagnosis.

          Aims:

          To assess utility of cell block preparation method in increasing sensitivity of cytodiagnosis in deep-seated image-guided FNACs.

          Settings and Design:

          This was a hospital-based observational study conducted in the Department of Pathology, over a period of one and a half years.

          Materials and Methods:

          A total of 46 cases of abdomino-pelvic and intrathoracic masses subjected to guided FNACs were included. Along with conventional smears, cell blocks were prepared by using AAF (95% Ethanol 34 ml + formalin 4 ml + Glacial acetic acid 2 ml) as fixative agent.

          Statistical Analysis Used:

          Done using MedCalc Version 12.7.5.0 to find out the sensitivity, specificity, and diagnostic accuracy of conventional smears and cell blocks.

          Results:

          The sensitivity, specificity, and diagnostic accuracy of cell blocks in our study was 71.11%, 100%, and 71.73%, respectively. The figures for FNA smears were 62.22%, 100%, and 63.04%, respectively.

          Conclusions:

          Cell block technique by AAF fixative is a simple, inexpensive procedure. Cell block method allows the recovery and processing of minute amounts of cellular material, facilitating better classification of tumor when reviewed along with cytological smears, the ability to obtain many sections for immunostains and other studies to be performed akin to paraffin sections produced in histopathology.

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          Most cited references21

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          Cell block cytology. Improved preparation and its efficacy in diagnostic cytology.

          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.
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            Critical analysis of cell block versus smear examination in effusions

            Objectives: To assess the utility of the cell block preparation method in increasing the sensitivity of cytodiagnosis of serous fluids and to know the primary site of malignant effusions. Materials and Methods: A total of 190 cases were subjected to routine smear examination as well as cell block preparation. After the cytological diagnosis, each case was objectively analysed for cellularity, arrangement (acini, papillae, cell balls, and proliferation spheres), cytoplasmic, and nuclear details. Results: Out of 190 cases, 70 cases were found to be malignant and had been examined in smears and paraffin-embedded cell blocks. Using a combination of the cell block and smear techniques yielded 13% more malignant cases than what were detected using smears by themselves. The combined technique helped to ascertain the primary site of malignancy in 83.3% of the cases, whereas the primary site could not be ascertained in 17.7% of the cases. Conclusions: The cell block technique not only increased the positive results, but also helped to demonstrate better architectural patterns, which could be of great help in making correct diagnosis of the primary site. The cell block technique was also useful for special stains and immunohistochemistry and can give morphological details by preserving the architectural patterns.
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              The cytologic criteria of malignancy.

              Cytology and cell biology are two separate fields that share a focus on cancer. Cancer is still diagnosed based on morphology, and surprisingly little is known about the molecular basis of the defining structural features. Cytology uses the smallest possible biopsy for diagnosis by reducing morphologic "criteria of malignancy" to the smallest scale. To begin to develop common ground, members of the American Society of Cytopathology Cell Biology Liaison Working Group classify some of the "criteria of malignancy" and review their relation to current cell biology concepts. The criteria of malignancy are extremely varied, apparently reflecting many different pathophysiologies in specific microenvironments. Criteria in Group 1 comprise tissue-level alterations that appear to relate to resistance to anoikis, alterations in cell adhesion molecules, and loss of apical-basal polarity. Criteria in Group 2 reflect genetic instability, including chromosomal and possibly epigenetic instability. Criteria in Groups 3 are subcellular structural changes involving cytoplasmic components, nuclear lamina, chromatin and nucleoli that cannot be accounted for by genetic instability. Some distinct criteria in Group 3 are known to be induced by cancer genes, but their precise structural basis remains obscure. The criteria of malignancy are not closely related to the histogenetic classification of cancers, and they appear to provide an alternative, biologically relevant framework for establishing common ground between cytologists and cell biologists. To understand the criteria of malignancy at a molecular level would improve diagnosis, and likely point to novel cell physiologies that are not encompassed by current cell biology concepts.
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                Author and article information

                Journal
                J Cytol
                J Cytol
                JCytol
                Journal of Cytology
                Medknow Publications & Media Pvt Ltd (India )
                0970-9371
                0974-5165
                Jul-Sep 2017
                : 34
                : 3
                : 133-138
                Affiliations
                [1]Department of Pathology, Amala Institute of Medical Sciences, Thrissur, Kerala, India
                Author notes
                Address for correspondence: Dr. Elizabath P Mathew, Department of Pathology, Amala Institute of Medical Sciences, Thrissur, Kerala, India. E-mail: elizabath.alex@ 123456gmail.com
                Article
                JCytol-34-133
                10.4103/JOC.JOC_82_15
                5492749
                b76b5860-1ff6-4027-9e33-90794e1a2755
                Copyright: © 2017 Journal of Cytology

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                History
                Categories
                Original Article

                Pathology
                cell block,conventional smears,image-guided fnacs
                Pathology
                cell block, conventional smears, image-guided fnacs

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