Diagnosis of Body Fluids Using a Combined Approach of Cytomorphology in Routinely Stained Smears and Cell Blocks: A Boon for Primary Health Care in this Era of Molecular Medicine!

Abstract

Accurate diagnosis of cells as reactive or malignant mesothelial cells in body fluids is a common problem. The limited sensitivity of cytodiagnosis in effusions primarily results from unclear morphological details of cells, cell overcrowding or overlapping, cell loss, and changes caused by diverse laboratory processing techniques. Numerous studies have observed that despite meticulous preparation, cytological assessments of fluid through smears often leave substantial unexplored residue, potentially harboring valuable diagnostic information. The unexplored residue can be easily and pragmatically assessed using the cell block method, where it is embedded in paraffin and examined alongside routine smears. Cell blocks prove especially beneficial when conventional cytological smear methods fall short in providing accurate diagnoses, as seen in cases such as reactive mesothelial cells, or when findings are ambiguous, as in occasional well-differentiated adenocarcinoma. The present study reviews the usefulness and benefits of cell block method in cyto-diagnosis of body fluids and highlight the importance of ancillary techniques such as immunohistochemistry (IHC) in improving the sensitivity of diagnosis. It was observed that isolated use of conventional smear misses the diagnosis when there is cell overcrowding, low cellularity, and deranged morphology. Hence, with the application of a simple cell block technique with or without ancillary techniques such as IHC, we can provide a quality report for better patient outcome even at the level of primary health care.

Keywords

• cell block
• conventional smear
• cytodiagnosis
• primary care