Comparative Evaluation of Conventional Cytology, Liquid-Based Cytology and Cell Block Technique for Cytopathological Analysis of Pleural Aspirates
Comparative evaluation of cytological methods
Abstract
Objective: To compare the diagnostic accuracy, practicality, and utility of conventional cytology (CC), liquid-based cytology (LBC), and cell block (CB) techniques in the cytopathological evaluation of pleural aspirates, aiming to determine the most effective method for diagnosing pleural effusion (PE), particularly in distinguishing between benign and malignant conditions.
Methods: A cross-sectional descriptive study involving sixty-eight patients aged over 18 years with non-traumatic pleural effusion confirmed by clinical evaluation and chest X-ray was conducted at Nnamdi Azikiwe University Teaching Hospital from January 31, 2020, to January 31, 2022. Pleural fluid samples were processed using three cytological techniques: CC, LBC, and CB. The slides were evaluated and categorized into five diagnostic categories: non-diagnostic, negative for malignancy, atypia of undetermined significance, suspicious for malignancy, and malignant. Statistical analysis was performed using SPSS version 22.
Results: The study included 40 males (58.8%) and 28 females (41.2%), with a mean age of 51.6 ± 17.12 years. Malignant effusions were observed in 23 patients (33.8%). The CB technique demonstrated superior performance with a sensitivity of 82.6%, specificity of 88.9%, and an accuracy of 1. In contrast, LBC showed a sensitivity of 65.2% and specificity of 55.6%, while CC had the lowest sensitivity (17.4%) and specificity (51.1%). The CB method also achieved the highest negative predictive value (NPV = 1), outperforming LBC (NPV = 0.956) and CC (NPV = 0.852).
Conclusion: The CB technique was found to be the most reliable method for the cytopathological evaluation of pleural aspirates, exhibiting the highest sensitivity, specificity, and diagnostic accuracy. The study highlights the importance of selecting advanced cytological methods such as CB to enhance diagnostic precision in clinical practice, particularly in the differentiation of malignant from benign pleural effusions.
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Assawasaksakul T, Boonsarngsuk V, Incharoen P. A comparative study of conventional cytology and cell block method in the diagnosis of pleural effusion. J Thorac Dis. 2017; 9(9):3161-3167. doi: 10.21037/jtd.2017.08.52.
Light RW. Pleural effusions. Med Clin North Am. 2011; 95(6):1055-70. doi: 10.1016/j.mcna.2011.08.005.
Sahn SA. Malignant pleural effusions. Semin Respir Crit Care Med. 2001; 22(6):607-16. doi: 10.1055/s-2001-18796.
Dağli AF, Küçük S, Sezer M, Uçer O. Cytopathologic diagnosis in pleural effusion and cyto-histopathologic correlation. Turk Patoloji Derg. 2011 Jan;27(1):12-6. doi: 10.5146/tjpath.2010.01041.
Effusion Guidelines Committee of IAC Guidelines drafting and finalization committee, Srinivasan R, Rekhi B, Rajwanshi A, Pathuthara S, Mathur S, et al. Indian Academy of Cytologists Guidelines for Collection, Preparation, Interpretation, and Reporting of Serous Effusion Fluid Samples. J Cytol. 2020; 37(1):1-11. doi: 10.4103/JOC.JOC_157_19.
Pinto D, Chandra A, Crothers BA, Kurtycz DFI, Schmitt F. The international system for reporting serous fluid cytopathology-diagnostic categories and clinical management. J Am Soc Cytopathol. 2020; 9(6):469-477. doi: 10.1016/j.jasc.2020.05.015.
Wu H, Khosla R, Rohatgi PK, Chauhan SS, Paal E, Chen W. The minimum volume of pleural fluid required to diagnose malignant pleural effusion: A retrospective study. Lung India. 2017 Jan-Feb;34(1):34-37. doi: 10.4103/0970-2113.197120.
Obahiagbon 1, Udoh MO. Challenges of pleural aspirate cytology: a 5-year retrospective review. Ann Trop Pathol. 2020; 11:3-7. Doi:10.4103/atp_30_19.
Thappar M, Mishra RK, Sharma A, Goyal V, Goyal V. Critical analysis of cell block versus smear examination in effusions J Cytol. 2009; 26:60–4. doi: 10.4103/0970-9371.55223.
Dadhich H, Toi PC, Siddaraju N, Sevvanthi K. A comparative analysis of conventional cytopreparatory and liquid based cytological techniques (Sure Path) in evaluation of serous effusion fluids. Diagn Cytopathol. 2016; 44(11):874-879. doi: 10.1002/dc.23567.
Hashmi AA, Naz S, Ahmed O, Yaqeen SR, Irfan M, Asif MG, Kamal A, Faridi N. Comparison of Liquid-Based Cytology and Conventional Papanicolaou Smear for Cervical Cancer Screening: An Experience From Pakistan. Cureus. 2020; 12(12):e12293. doi: 10.7759/cureus.12293.
Rani SSS, Vamshidhar IS, John NA, John J. Diagnosis of Pleural Fluid Effusions by Cell Block and Pleural Biopsy - A Comparative Study. J Cytol. 2022 Oct-Dec;39(4):169-173. doi: 10.4103/joc.joc_91_21
Acharya S. Diagnostic Utility of Pleural Fluid Cytology versus Cell Block Technique: A Comparative Study. J. Nepalgunj Med. College. 2023; 21(1):49-52. https://doi.org/10.3126/jngmc.v21i1.58301
Poon IK, Chan RCK, Choi JSH, Ng JKM, Tang KT, Wong YYH, et al. A comparative study of diagnostic accuracy in 3026 pleural biopsies and matched pleural effusion cytology with clinical correlation. Cancer Med. 2023; 12:1471-1481. doi:10.1002/cam4.5038.
Shivakumarswamy U, Arakeri SU, Karigowdar MH, Yelikar B. Diagnostic utility of the cell block method versus the conventional smear study in pleural fluid cytology. J Cytol 2012; 29:11-5.
Saha SP, Bhalla DK, Whayne TF Jr, Gairola C. Cigarette smoke and adverse health effects: An overview of research trends and future needs. Int J Angiol. 2007;16(3):77-83. doi: 10.1055/s-0031-1278254.
Husain S, Prakash CJ, Sharmila PS, Vinitra K. (). Cytological study of body fluids for malignancy. Tropical Journal of Pathology and Microbiology. 2019; 5(1): 43-50. https://doi.org/10.17511/jopm.2019.i01.08
Mohammed MA, El-Badawi ZH, Alaa Edin HSE, Abd El-Aal KM, Muhammad EMS. A Comparative Study of Conventional Cytology and Cell block Method in Diagnosis of Pleural Effusion and their Correlation with Clinicopathological and Radiological Diagnosis. Med. J. Cairo Univ. 2019; 87 (7): 4521-4527. DOI: 10.21608/mjcu.2019.80697
Torous VF. How much is enough: investigation of pleural fluid cytology findings related to sample volume. J Am Soc Cytopathol. 2022;11(2):94-101. doi: 10.1016/j.jasc.2021.12.002.
Mercer RM, Varatharajah R, Shepherd G, Lu Q, Castro-Añón O, McCracken DJ, et al. Critical analysis of the utility of initial pleural aspiration in the diagnosis and management of suspected malignant pleural effusion. BMJ Open Respiratory Research. 2020; 7: e000701. doi: 10.1136/bmjresp-2020-000701
Nemade SH, Kamal MM. Body fluids: Comparison of liquid based cytology with conventional cytopreparatory technique. Indian J Pathol Microbiol. 2023;66(1):75-80. doi: 10.4103/ijpm.ijpm_1182_21.
Buch AC, Londhe MM, Patil TV, Rathod H, Dhaliwal S, Gore GR, et al. Comparison of liquid-based cytology and conventional preparations in nongynecological cytology. Int. J Acad Med. 2023; 9(3): 126-131. DOI: 10.4103/ijam.ijam_25_23
Joshi A, Mahajan N, Karmarkar PJ, Mahore SD. Diagnostic utility of various techniques used in body fluid cytology. IOSR- JDMS 2014; 13(1): 13-8. DOI:10.9790/0853-13151318.
Saha R, Sardar S, Das S. Role of liquid-based cytology and cell block study of pleural fluid in the evaluation of cases of malignant Pleural effusion with special reference to immunohistochemistry. Int J Med Res Rev. 2021;9(3):185-192. DOI: https://doi.org/10.17511/ijmrr.2021.i03.09
Bhanvadia VM, Santwani PM, Vachhani JH. Analysis of diagnostic value of cytological smear method versus cell block method in body fluid cytology: study of 150 cases. Ethiop J Health Sci 2014;24: 125-31. 10.4314/ejhs.v24i2.4
