Morphologic and immunocytochemical performances of effusion cell blocks prepared using 3 different methods

Our plain-English summary of Morphologic and immunocytochemical performances of effusion cell blocks prepared using 3 different methods, by X. Jing, Q.K. Li, U. Bedrossian, et al (American Journal of Clinical Pathology, 2013).

The study

• Authors: X. Jing, Q.K. Li, U. Bedrossian, C.W. Michael
• Journal: American Journal of Clinical Pathology
• Published: 2013;139(2):177-82
• Cited by: 33 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

With increased use of the ThinPrep method for nongynecologic specimens, cell blocks are more commonly prepared by harvesting cells that are fixed in CytoLyt solution. The current study compared morphologic and immunocytochemical performance of effusion cell blocks prepared using CytoLyt-prefixed thrombin clot (CTC) with plasma thrombin clot (PT) and HistoGel (HG) preparation. The study included a total of 25 malignant or benign serous fluids. Three individual cell block materials were simultaneously prepared from each of the 25 effusion specimens using the CTC, PT, or HG method. H&E staining and immunostaining for pancytokeratin (pan-CK), carcinoembryonic antigen (CEA), epithelial membrane antigen (EMA), B72.3, HBME-1, estrogen receptor (ER), progesterone receptor (PR), CD45, CD20, and CD3 were then performed. The CTC preparation revealed compatible cellularity and good cellular details. In addition, CTC cell blocks revealed a similar percentage of cells with positive immunostaining along with the strongest intensity and the least background staining. The CTC method can be used reliably as an adjunct to other preparation techniques.

In plain English

This laboratory study compared three ways of making cell blocks, which are small paraffin-embedded samples of cells, from serous body fluids (effusions). The authors used 25 fluid specimens: 16 adenocarcinomas, 2 mesotheliomas, 4 lymphomas and 3 negative effusions. From each specimen they made three blocks at the same time. One was a plasma thrombin clot (PT). One used HistoGel agar (HG). One was a plasma thrombin clot made after the cells were fixed in CytoLyt, a methanol-based solution (CTC). The blocks were stained with H&E and with ten antibody stains. CTC blocks held about as many cells as PT blocks, and HG blocks held the fewest. PT blocks preserved cells best overall. Still, the number of blocks graded good was similar: 21 of 25 for CTC, 22 of 25 for PT and 21 of 25 for HG. The share of cells staining positive was similar across methods. CTC blocks showed the most intense staining and the least background staining, and no method gave false-positive staining. The authors concluded that the CTC method can be used reliably alongside common techniques. Asbestos exposure was not studied.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Laboratory methods comparison: three cell block preparation methods (PT, HG, CTC) prepared simultaneously from each specimen and compared on morphology and immunostaining
• Who was studied: 25 serous fluid specimens: 16 adenocarcinomas, 2 mesotheliomas, 4 lymphomas and 3 negative effusions. Location and dates are not stated.
• Exposure: No asbestos or occupational exposure was studied. The variable compared was the cell block preparation method: plasma thrombin clot, HistoGel, or plasma thrombin clot after prefixation in methanol-based CytoLyt solution.
• Main results:
  • CTC sections had cellularity comparable to PT sections, and HG sections had the least cellularity. Moderate or high cellularity was seen in 21 of 25 CTC blocks (84%), 22 of 25 PT blocks (88%) and 20 of 25 HG blocks (80%), as given in Table 2.
  • PT blocks showed the best overall morphologic preservation with minimal artifacts. HG cells showed exaggerated vacuoles, denser cytoplasm and frayed borders. CTC cells showed more shrinkage and nuclear-cytoplasmic holes.
  • Proportions of blocks with good versus fair preservation were similar across methods. Good preservation was seen in 21 of 25 CTC blocks (84%), 22 of 25 PT blocks (88%) and 21 of 25 HG blocks (84%), as given in Table 2.
  • The percentage of cells with positive immunostaining was similar regardless of method. For example, pan-CK was positive in 17 of 18 epithelial specimens (94%) with CTC and PT and 16 of 18 (89%) with HG, as given in Table 3.
  • CTC blocks showed the most intense staining and the least background staining. No false-positive staining was seen with any method.
• The authors' conclusion: The authors concluded that effusion cell blocks made with the CTC method gave compatible cellularity and good cellular detail. They found that preservation in CytoLyt did not interfere with immunostaining, and that the method can be used reliably as an adjunct to commonly used techniques.
• Limitations the authors state:
  • Effusions are not routinely collected in CytoLyt solution. CytoLyt collection was simulated for this study, and the authors chose effusions for their range of diseases and their cellularity.

Topics

Medical terms in this study, explained in our Lexicon: Cell Block, Serous Fluid, Carcinoembryonic Antigen (CEA), Epithelial Membrane Antigen (EMA), B72.3 (TAG-72), HBME-1.

Related studies

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• Cytological differential diagnosis among adenocarcinoma, epithelial mesothelioma, and reactive mesothelial cells in serous effusions by immunocytochemistry — X.Y. Su, G.D. Li, et al. (2011)
• Quality control of immunocytochemical staining of effusions using a standardized method of cell processing — V. Kuenen-Boumeester, P. van Loenen, et al. (1996)
• Diagnostic usefulness of EMA, IMP3, and GLUT-1 for the immunocytochemical distinction of malignant cells from reactive mesothelial cells in effusion cytology using cytospin preparations — K. Ikeda, G. Tate, et al. (2011)
• IMP3/L523S, a novel immunocytochemical marker that distinguishes benign and malignant cells: the expression profiles of IMP3/L523S in effusion cytology — K. Ikeda, G. Tate, et al. (2010)
• Detection of cancer cells in effusions from patients diagnosed with gynaecological malignancies. Evaluation of five epithelial markers — B. Davidson, B. Risberg, et al. (1999)

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