Cell block as an adjunct to conventional Papanicolaou smear for diagnosis of cervical cancer in resource-limited settings

Comparison of liquid-based cytology and cell blocks prepared from cell remnants for diagnosis of cervical pathology

BACKGROUND

Cervical cancer is a global public health problem with high mortality. Advances in screening programs for cervical cancer are considered key to eliminate cervical cancer. We aimed to examine the contribution of cell block analysis to the detection of epithelial cell abnormalities in cervical smear samples.

METHODS

A total of 559 patients with suspected cervical pathology were examined, and their samples were analyzed by both liquid-based cytology (LBC) and cell blocks. The biopsy results of 149 out of the 559 patients were obtained.

RESULTS

Of the 50 patients who were identified as HSIL by biopsy, only 12 were diagnosed as HSIL by the LBC method, 22 as LSIL, 12 as ASCUS, and 4 as ASC-H (p < 0.001). With the cell block analysis, results for these patients were: 20 HSIL, 17 LSIL, 7 NILM, 4 'unsatisfactory', and 2 ASC cases (p < 0.001). LBC detected only 1 of the 10 patients with biopsy-diagnosed tumors, while 7 of these were defined as HSIL, 1 as ASCUS and 1 as AGC. The results of cell block analysis in patients with biopsy-diagnosed tumors were as follows: 7 HSIL, 1 tumor, 1 ASC and 1 LSIL.

CONCLUSIONS

Cell block analysis might be superior to LBC in terms of diagnostic accuracy in cervical pathologies, particularly in the detection of HSIL. However, both methods were similarly poor in diagnosing tumors. Cell blocks may improve diagnostic accuracy and can be a complementary method to LBC, while having the advantage of revealing histological architecture.

Survival Impact of Residual Cancer Cells in Intraoperative Peritoneal Washes following Radical Hysterectomy for Cervical Cancer

Objective: Residual cancer cells (RCCs) contribute to cancer recurrence either because of tumor spillage or undetectable pre-existing micrometastatic tumor clones. We hypothesized that the pathologic evaluation of intraoperative peritoneal washes may reveal RCCs. The aim of this study was to evaluate the survival impact of RCCs identified in intraoperative peritoneal washes and their correlation with clinicopathologic parameters following radical hysterectomy for cervical cancer. Methods: A total of 229 patients with cervical cancer who underwent radical hysterectomy with pelvic and/or paraaortic lymphadenectomy were included. The intraoperative peritoneal washes after surgery were filtered through a strainer and the presence of tumor cells in the residual aspirate was determined. Univariate and multivariate analyses of clinicopathological parameters were performed to identify predictors of recurrence. Results: RCCs in intraoperative peritoneal washes were identified in 19 patients (8.3%). Multivariate analysis revealed that deep stromal invasion (hazard ratio [HR], 13.32; 95% confidence interval [CI], 1.81–98.27; p = 0.0111), lymph node metastasis (HR, 2.00; 95% CI, 1.01–3.99; p = 0.0482), and neoadjuvant chemotherapy (HR, 2.34; 95% CI, 1.89–4.61; p = 0.0139) were associated with tumor recurrence. However, the presence of RCCs was not associated with tumor recurrence (HR, 2.60; 95% CI, 0.74–9.11; p = 0.1352). Multiple logistic regression analysis revealed that RCCs were associated with neoadjuvant chemotherapy (odds ratio [OR], 0.22; 95% CI, 0.05–0.99; p = 0.0488) and large tumor size (OR, 4.16; 95% CI, 0.77–22.48; p = 0.0981). Conclusions: Although the presence of RCCs in intraoperative peritoneal washes do not significantly impact survival outcomes, there was a tendency of inferior survival outcomes in patients with RCCs. RCCs were associated with neoadjuvant chemotherapy and large tumor size.

Diagnostic efficacy of ascites cell block for ovarian clear cell carcinoma

BACKGROUND

Ascites cytology is important for determining the stage and treatment methods for ovarian clear cell carcinoma (CCC) as defined by the 2014 International Federation of Obstetrics and Gynecology classification.

METHODS

Patients with CCC who underwent surgery at our hospital between January 2012 and December 2019 and who received cytodiagnosis of their ascites using Papanicolaou (Pap) and May-Grünwald-Giemsa (MGG) staining, and cell block methods were identified. The cell block technique was performed using hematoxylin-eosin (H&E) staining and immunohistochemical staining for hepatocyte nuclear factor-1β (HNF-1β), estrogen receptor (ER), progesterone receptor (PR), and Wilms tumor-1 (WT-1). Cancer cells of CCC were defined as tumor cells that were positive for HNF-1β and negative for ER, PR, and WT-1. The diagnostic accuracy of ascites cytology using Pap and MGG staining and cell block methods was examined.

RESULTS

Based on cytological data, our study included 17 patients: seven (41.1%) with malignant (MAL) ascites, eight (47.1%) with negative for malignancy (NFM), and two (11.8%) with atypia of undetermined significance (AUS) because of a few atypical cells based on Pap and MGG staining. Malignant cells diagnosed by cell blocks were detected in 7/7 patients with MAL ascites based on PAP and MGG staining, 2/8 (25.0%) patients with NFM, and 1/2 (50%) patients with AUS.

CONCLUSION

These findings show that the cell block method combined with the immunohistochemical investigation may be useful for increasing the diagnostic accuracy of malignant cells in CCC.

Architectural aspects of cell-blocks as small biopsies

Cell-block preparations have become an essential part of integrated cytology diagnosis. They are essentially microbiopsies that are formalin fixed and embedded in paraffin. This has become more prevalent with greater sample procurement due to the advent of newer biopsy techniques and needles. Cell-blocks allow retrieval of small tissue fragments from cytology specimens that sometimes cannot be processed by alternate cytologic techniques. They represent concentrated, cell-enriched preparations that provide cytologists with the opportunity to evaluate cellular architecture, as well as to perform ancillary testing. A cell-block compatible sample may thus obviate the need for a more invasive procedure such as a tissue biopsy. Microscopic examination of cell-blocks is quick, avoids obscuring material, permits cells to be evaluated in one focal plane, and allows the histologic architecture such as glandular differentiation, papillary formations, and sometimes invasion to be easily identified. This new era of “cytohistology” accordingly requires practicing cytologists to become more familiar with histopathology. This review article discusses the benefit of various architectural patterns identifiable in cell-blocks employed as an adjunct to Pap tests, exfoliative fluid specimens, and fine-needle aspirations.

The utility of pap cell block preparations with liqui-PREP™ cell pellets to clarify the cytological diagnosis of atypical squamous cells of undetermined significance and atypical glandular cells

OBJECTIVE

Atypical squamous cells of undetermined significance (ASCUS) and atypical glandular cells (AGC) reflect cellular abnormalities insufficient for clear diagnosis. We used cell pellets obtained from liquid-based cytology (LBC) to prepare cell blocks (CB) and clarify the initial diagnosis of ASCUS and AGC.

STUDY DESIGN

A total of 393 CBs with initial diagnosis of ASCUS or AGC were processed. Of those, 305 of the ASCUS and 20 of the AGC had adequate specimens. We compared results of CBs prepared from ASCUS and AGC to determine which had higher frequencies of higher-grade lesions.

RESULTS

A majority of specimens (83%) were adequate for evaluation. Compared with the initial diagnosis, 14% (42/305) of ASCUS were diagnosed with low-grade squamous intraepithelial lesion (LSIL) in CB, while 10% (2/20) of AGC were diagnosed with LSIL or adenocarcinoma. No statistical relationship between the initial diagnosis of ASCUS and AGC and results of higher-grade lesions in CB is evident as determined by p value greater than 0.05 (p = 0.228).

CONCLUSIONS

CBs prepared from Liqui-PREP cell pellets are, in most cases, assessable and can be useful as an adjunctive test to help clarify the initial diagnosis of ASCUS and AGC. Diagn. Cytopathol. 2017;45:520-525. © 2017 Wiley Periodicals, Inc.

Cell Block Preparation versus Liquid-Based Thin-Layer Cervical Cytology: A Comparative Study Evaluating Human Papillomavirus Testing by Hybrid Capture-2/Cervista, in situ Hybridization and p16 Immunohistochemistry

OBJECTIVE

Cell block (CB) preparations from residual liquid-based Pap samples have been shown to be of diagnostic value. In this study we evaluated human papillomavirus (HPV) in situ hybridization (ISH) and p16 immunohistochemistry (IHC) on CB preparations and compared the results with the primary diagnosis and standard HPV tests.

DESIGN

In total, 197 HE-stained CB slides prepared from CBs from residual Pap samples (152 ASCUS, 2 ASC-H, 32 LGSIL, 4 HGSIL, 1 AGUS and 6 normal) were analyzed. Hybrid Capture-2 (HC-2)/Cervista testing and HPV ISH and p16 IHC were performed on the CB samples. The test performance characteristics were compared with HPV and p16 assay performances.

RESULTS

The cellular architecture was well maintained in CBs with excellent consistency. HPV ISH testing had an excellent concordance with the HC-2/Cervista methods (85%) with high sensitivity (82.6%; 95% CI 75.9, 89.4) and specificity (89.3%). Of all the p16 tests, 38% were positive (60 out of 159 samples). The overall concordance between p16 and HC-2/Cervista (64%), or between p16 and ISH (68%), was lower than the concordance between ISH and HC-2/Cervista (85%).

CONCLUSIONS

HPV ISH and p16 IHC testing is feasible, cost effective and practical. A combination of the two tests would ultimately improve diagnostic accuracy, leading to better therapeutic decisions.

Whole-Slide Imaging of Pap Cellblock Preparations Is a Potentially Valid Screening Method

OBJECTIVE

To date, the impact of digital imaging on routine cytology remains far from perfect. Cellblock (CB) preparations from Pap samples have been shown to be diagnostically valuable. We evaluated the validity of utilizing whole-slide imaging (WSI) prepared from Pap CBs as a screening tool.

STUDY DESIGN

A total of 1,110 CB slides prepared from residual Pap samples were analyzed - 563 normal, 282 atypical squamous cells of undetermined significance (ASCUS), 12 atypical squamous cells-cannot exclude high-grade squamous intraepithelial lesion, 188 low-grade squamous intraepithelial lesions (LSIL), 36 high-grade squamous intraepithelial lesions (HSIL), 25 atypical glandular cells of undetermined significance, 1 adenocarcinoma in situ, 2 invasive adenocarcinomas, and 1 squamous cell carcinoma. Virtual slides were obtained using the Aperio system. Test performance characteristics of liquid-based samples and WSI from CB samples were compared.

RESULTS

Average sensitivity and specificity of the five WSI reviewers was 58.3 and 85.1% for ASCUS, respectively, 54.1 and 93.9% for LSIL, and 51.8 and 98.8% for HSIL. Overall WSI sensitivity and specificity for detecting lesions was 82.1 and 86.2%, respectively. Agreement (kappa values) between WSI reviewers was 0.56 for ASCUS, 0.69 for LSIL, 0.67 for HSIL, and 0.74 for negative samples.

CONCLUSIONS

WSI of CB preparations is a feasible method to achieve high-quality specimen preparations. It is as sensitive as liquid-based methods and appears to be highly specific for the detection of LSIL and HSIL.

Whole Slide Imaging of Pap Cell Block Preparations versus Liquid-Based Thin-Layer Cervical Cytology: A Comparative Study Evaluating the Detection of Organisms and Nonneoplastic Findings

OBJECTIVE

Cervical cancer is one of the most common malignancies worldwide, yet it is preventable by population screening. In a previous study, we confirmed the feasibility of utilizing whole slide imaging (WSI) of cell block (CB) preparations to overcome the limitations of digitizing cytologic samples. In this study, we evaluated the accuracy of WSI in identifying various organisms and nonneoplastic findings.

STUDY DESIGN

A total of 335 WS images from Pap CB preparations were analyzed using the Aperio system. The test performance characteristics of ThinPrep (TP) and WSI samples were compared for adequacy, for the presence of bacterial vaginosis (BV), fungi, Trichomonas vaginalis (TV) and herpes simplex virus (HSV) and for nonneoplastic findings.

RESULTS

The WSI samples contained optimal material from all preparations. BV was diagnosed in 33 WSI versus 36 TP samples. Budding yeasts and/or pseudohyphal forms were noted in 18 WSI versus 19 TP samples. TV organisms (10 of 11 samples) and 1 HSV case were accurately identified in the WSI and TP samples. Squamous metaplasia, keratosis and reactive/reparative and inflammatory changes were easily identified by WSI.

CONCLUSIONS

The concept of WSI from Pap CB preparations is potentially feasible for adoption. Digital remote web-based technology eliminates the need for an individual on site, saving time and resources.

Preparation of cell blocks for lung cancer diagnosis and prediction: protocol and experience of a high-volume center

Minimally invasive diagnostic techniques are increasingly being used to obtain specimens for pathological diagnosis and prediction. Referring to lung cancer, both endobronchial and endoesophageal ultrasound are used worldwide as diagnostic routine methods. Consequently, an increasing number of pathological samples are cytological and fewer are histological. On the other hand, the requirements for specific and sensitive tumor subtyping complemented by predictive analyses are steadily increasing and are an essential basis for evidence-based treatment decisions. In this article we focus on the cell block method as a helpful tool for diagnostic and predictive analyses in lung cancer and point out its advantages and disadvantages in comparison to conventional cytological and biopsy specimens. Furthermore, we retrospectively analyze the diagnostic results of the cell block method in a high-volume center over 5 years. The main advantages of cell blocks are the availability of established and validated protocols, archiving and the opportunity to have serial sections from the same specimens to provide or repeat molecular analyses. Actually, in case of tumor progression, even additional biomarkers can be tested using the original cell block when re-biopsies are not feasible. The cell block method should be considered as a reliable, complimentary approach to conventional cytological or biopsy procedures, which is helpful to fulfill the increasing requirements of high-quality diagnostics and prediction.

High-risk human papillomavirus DNA test results are useful for disease risk stratification in women with unsatisfactory liquid-based cytology pap test results

OBJECTIVES

This study assesses whether high-risk human papillomavirus (HPV) DNA test results from residual vial fluid of unsatisfactory liquid-based cytology(LBC) samples might provide useful information on disease risk.

MATERIALS AND METHODS

Patients with unsatisfactory imaged ThinPrep Pap test results and available Hybrid Capture 2 high-risk HPV results were identified at an academic women's hospital laboratory between July 1, 2005, and July 31, 2007. Follow-up repeat cytology results, HPV results, and available biopsy results were analyzed.

RESULTS

Three hundred four patients with unsatisfactory cytology results and HPV test results were studied. Eleven (3.6%) of 304 tested positive for HPV DNA, and 293 tested HPV negative. Five (45%) of 11 HPV-positive patients had detectible low-grade squamous intraepithelial/cervical intraepithelial neoplasia 1 during a mean follow-up period of almost 6 months. Among 293 women with negative HPV results, only 1 case of cervical intraepithelial neoplasia 1 was identified during roughly the same follow-up period.

CONCLUSIONS

A positive high-risk HPV result associated with an unsatisfactory ThinPrep Pap test result identified patients at risk for diagnosis of an undetected squamous intraepithelial/cervical intraepithelial neoplasia. Negative high-risk HPV results associated with an unsatisfactory LBC had high negative predictive value in this limited study. The overall low detection rate for significant disease on follow-up of all patients with unsatisfactory imaged LBC is similar to findings reported in another LBC study but differs from studies reporting increased risk for undetected disease in women screened with unsatisfactory conventional Pap smears.