Abstract

Cytological examination of serous fluids is one of the commonly performed investigation. It is crucial to distinguish between benign and malignant effusions, as it is important for determining the prognosis and treatment of the patient. Diagnostic problem arises in everyday practice to differentiate reactive atypical mesothelial cells from malignant cells by routine conventional smear method. Cytocentrifuge will provide better quality smears for interpretation and cell block technique provides better architectural pattern, morphological features and an additional yield of malignant cells, and thereby, increasing the sensitivity of the cytodiagnosis when compared to conventional smears. Aim: To compare the cytomorphological features of aspirates from body cavities using conventional smear, cytospin, cell block technique and perform IHC stains on cell block material in the diagnosis of malignant serous effusion. Materials and Methods: A total of 262 serous fluid samples over a period of two years, were subjected to simultaneous processing by conventional smear, cytocentrifuge and cell block technique. Results were compared for general cytological, cellular features and diagnostic utility for malignancy. Results: Samples comprised of 172 pleural, 82 peritoneal and 8 pericardial effusions. Conventional smear and cell block provided significantly better staining quality and morphological features. Cell block and cytospin cytology provided significantly high cellularity. Minimal overlapping of cells were significantly seen in cytocentrifuge smears. Additional yield for malignancy was 4% more by cell block method. Conclusion: The cell block technique not only increased the positive results for malignancy, 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. Cell block with ancillary technique like immunohistochemistry enhanced diagnostic accuracy.

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