Comparative study of cell block versus centrifuged smear examination from aspirates of cystic lesions

  • S R Niveditha Kempegowda Institute of Medical sciences
  • Thejasvi Krishnamurthy Kempegowda Institute of Medical sciences
  • Sumitha Prakash Rajarajeshwari Medical College
Keywords: Cystic Lesions, Cell Block, Centrifuged Smear, Fixed Sediment Method


Background: Cystic fluids encountered during routine FNA poses a diagnostic challenge to cytopathologists due to its low cell yield with high dispersal of cells on conventional centrifuged smears (CS).  Cell Block (CB) technique enables retrieval of small tissue fragments from fluids, thereby providing scope for better morphology and material for ancillary techniques which help in improving the diagnosis.Aim: To compare the efficacy of CB versus CS, in cyto-diagnosis of cystic lesions.Methods:  This observational study was conducted on a total of 50 fluid samples aspirated from cystic lesions during routine FNA and fluids aspirated peri-operatively from cystic ovarian lesions. Divided into two equal parts, one part was processed for CS and CB by Fixed Sediment Method and relevant immunohistochemistry was performed. CSs were categorized as positive for malignancy, benign diagnosis, Inadequate for opinion and suspicious for malignancy.  CBs were categorized as; no material, Non-contributory (CS+, CB-), confirms the smear diagnosis and establishes a specific diagnosis. The comparison between CS and CB was analysed by Chi- square test & kappa test.  Results: Out of the 50 cases, 35(70%) were given a benign diagnosis, 10 (20%) were positive for malignancy, 2(4%) were suspicious and 3(6%) were inadequate for opinion on CS. In CB out of 50 cases, 29 of them confirmed/established a diagnosis and 21 cases were non diagnostic / non-contributory. CB gave an improved diagnosis  in 2 out of 10 (20% ) malignant cases and 2 out  of 35  (5.7%) benign cases.( p value = 0.00054, Kappa value =0.34)            Conclusions: CBs complemented CS, more so in malignant lesions by preserved architecture. Aspirates from multiple sites of the cystic lesions (with/without radiological assistance)   pooled as one specimen yielded better material for CBs and ancillary techniques like histochemistry and IHC.  DOI: 10.21276/APALM.1249

Author Biographies

S R Niveditha, Kempegowda Institute of Medical sciences
professordepartment of pathology
Thejasvi Krishnamurthy, Kempegowda Institute of Medical sciences
assistant professordepartment of pathology
Sumitha Prakash, Rajarajeshwari Medical College
assistant professordepartment of pathology


1. Ansari NA, Derias NW. Fine needle aspiration cytology. J Clin Pathol 1997;50 : 41-3.
2. Khan S, Omar T, Michelow P. Effectiveness cell block technique in diagnostic cytopathology. J of Cytol 2012;29:177-82.
3. Karnauchow PN, Bounin RE. Cell block technique for fine needle aspiration biopsy. J Clin Pathol 1982;35:688.
4. Kung IT, Yuen RW, Chan JK. Optimal formalin fixation and processing schedule of cell blocks from the fine needle aspirates. Pathology 1989;21: 143-5.
5. Wojcik EM, Selvaggi SM. Comparison of smears and cell blocks in the fine needle aspiration diagnosis of recurrent gynecologic malignancies. Acta Cytol 1991;35:773-6.
6. Yang GC, Wan LS, Papellas J, Waisman J. Compact cell blocks. Use for body fluids, Fine needle aspirations and Endometrial brush biopsies. Acta Cytol 1998;42:703-6.
7. Zito FA, Gadaleta CD, Salvatore C, Filatico R, Labriola A, Marzullo A et al. A modified cell-block technique for fine needle aspiration cytology. Acta Cytol 1995;39: 93-9.
8. Liu K, Dodge R, Glasgow BJ. Fine needle aspiration: comparison of smear, cytospin and cellblock preparations in diagnostic and cost effectiveness. Diagn Cytopathol 1998;19:70-4.
9. Saleh HA, Hammoud J, Zakaria R, Khan AZ. Comparison of Thin-Prep and Cell block preparation for the evaluation of Thyroid epithelial lesions on fine needle aspiration biopsy. CytoJournal 2008;5-3.
10. Panlanowitz L, Freeman J, Goulart RA. Utility of cellblock preparation in cytologic specimens diagnostic of lymphoma. Acta Cytol 2010;54:236-7.
11. Oenning ACC, Rivero ERC, Calvo MCM, Meurer MI, Grando L J. Evaluation of the cell block technique as an auxiliary method of diagnosing jawbone lesions. Braz Oral Res 2012;26:355-9.
12. Rivero ERC, Grando LJ, Manegat F, Claus JDP, Xavier F. Cell block technique as a complementaty method in the clinical diagnosis of cyst-like lesions of the jaw. J Appl Oral Scin 2011;19:269-73.
13. Hegazy RA, Hegazy AA. FNAC and cell block study of thyroid lesions. Universal Journal of Medical Science 2013; 1:1-8.
14. Nguyen CK, Lee MW, Ginsberg J, Wragg T, Bilodeau D. Fine needle aspiration of the thyroid: an overview. Cyto Journal 2005;2:12.
15. Khurana KK, Ramzy I, Truong LD. p 53 immunolocalization in cell block preparation of squamous lesions of neck: an adjunct to fine needle aspiration diagnosis of malignancy. Arch Pathol Lab Med 1999;123:421- 5.
16. Xiao GQ. Fine needle aspiration of cystic pancreatic mucinous tumor: oncotic cells as an aiding diagnostic feature in paucicellular specimens. Diagn Cytopathol 2009;37:111-6.
17. Koss LG. Effusions in the absence of cancer. In: Koss LG, Melamed MR, editors. Diagnostic Cytology and its Histopathologic Basis, 5th edition, Philadelphia: Lippincott Williams & Wilkins; 2006. p. 919-48.
18. Nathan NA, Narayan E, Smith MA, Horn MJ. Cell block cytology: Improved preparation and its efficacy in diagnostic cytology. Am J Clin Pathol 2000;114:599-06.
19. Jain D, Mathur SR, Iyer V K. Cell blocks in cytopathology: a review of preparative methods, utility in diagnosis and role in ancillary studies. Cytopathology 2014;25:356-71.
20. Radhika S, Nijhawan R, Das A, Dey P. Ameloblastoma of the mandible: diagnosis by fine needle aspiration cytology. Diagn Cytopathol 1993;9:310-3.
21. Narayan SM, Padmini J, Parthiban R, Madhusmita J, Natarajan G, Revadi PS. Diagnosis of a case of papillary-cystic variant of acinic – cell carcinoma on fine needle aspiration cytology: Myriad of cyto-morphological features. International Journal of Case Reports and Images 2014;5:18-22.
22. Kim AR, Park SJ, Gu MJ, Kim HJ. Fine needle aspiration cytology of hepatic hyadatid cyst: a case study. The Korean J Pathol 2013;47:395-8.
23. Dahima S, Hegde P, Shetty P. Cell Block a forgotten tool. J of Mol Path Epidemol 2015:1:1
24. Trimbos JB, Hacker NF. The case against aspirating ovarian cysts. Cancer 1993;72:828-31.
25. Sherman ME: Cytopathology. In: Kurman RJ (ed). Blaustein's Pathology of the Female Genital Tract, 4th ed. New York: Springer-Verlag;1994. p. 1120–22.
26. Mayall F, Chang B, Darlington A. A review of 50 consecutive cytology cell block preparations in a large general hospital. J Clin Pathol 1997;50:985-90.
Original Article