Comparing Conventional Cytology Smear and Cell Block Techniques for Ovarian Cancer Diagnosis: A Prospective Observational Study

Abstract

Introduction: The cytological examination of ascitic fluid is widely recognised and well-documented for its importance in staging and prognosis of malignancy, and for providing information about inflammatory lesions. The Cell Block (CB) method offers improved architectural patterns and morphological features, aiding in the differentiation between reactive mesothelial cells and malignant cells, thus enhancing the efficacy of cyst diagnosis. Additionally, the CB technique finds applications in molecular biology and immunocytochemistry, making it advantageous for targeted therapy due to its ability to preserve cytological material. Aim: To compare the accuracy of conventional cytology smear technique and CB from ascitic fluid with histopathology for diagnosing ovarian tumours. Materials and Methods: A cross-sectional study was conducted in the Department of Pathology at Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, India. A total of 45 patients with suspected ovarian tumours or presence of ascites were included. Biopsy samples were sent to the pathology laboratory for histological evaluation, while study samples were collected from the Department of Pathology between January 2021 and December 2022. Sample processing techniques, such as conventional cytology {including cytocentrifugation before Giemsa, Pap, and Haematoxylin and Eosin (H&E) staining} and thromboplastin-plasma technique for CB preparation, were employed. Evaluation parameters included comparing morphological features of frequently stained cytology smears and CB technique of ascitic fluid, along with their concordance with histopathological diagnosis. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) program for Windows, version 28.0. Results: Among 45 patients, majority 24 (53.40%) of them belonged to 41-60 years of age group. It was noted that 24 (53.40%) patients had ascites, 11 patients (24.40%) had abdominal pain with ascites, and 10 (22.20%) had ovarian mass with ascites. Conventional cytology smear diagnoses revealed that 22 (48.9%) patients had infiltrates of serous cystadenocarcinoma. A significant correlation was found between the findings of the CB and Conventional Smear (CS) (p=0.0001), with a sensitivity of 94.12%, specificity of 100%, Positive Predictive Value (PPV) of 100%, Negative Predictive Value (NPV) of 85.71%, and a diagnostic accuracy of 95.65% for CB correlating with CS. Conclusion: A combined strategy utilising stained cytology smears and the CB technique of ascitic fluid could be considered in the diagnostic approach for malignant ovarian tumours.

Keywords

• cystadenocarcinoma
• inflammatory lesions
• ovarian tumours
• serum-ascites-albumin gradient