A technique to improve diagnostic information from fine‐needle aspirations

Abstract

BACKGROUND:Cytologic examination of fine‐needle aspiration (FNA) material is being used increasingly for the diagnosis of pulmonary lesions. Accurate distinction between nonsmall cell lung cancer (NSCLC), including subgroups, and small cell lung cancer and between primary lung cancer and metastases has therapeutic impact. However, the distinction between these groups may be difficult on smears. In this report, the authors describe a simple method, called cytoscrape (CS), which can be used on virtually any smear to produce material useful for ancillary methods, including immunohistochemistry.METHODS:Aspirates from 47 patients who had possible malignant infiltrates identified on computed tomography scans of the chest were included. Smears were stained by May‐Grunwald‐Giemsa and Diff‐Quick for diagnostic purposes. CS material was obtained by gently scraping cells off the slides. Clots were made, and the sections were stained for thyroid transcription factor‐1 (TTF‐1) and mucin. The utility of the CS technique was evaluated by assessing the sensitivity and specificity of the method and by quantifying the extra diagnostic information obtained by the method relative to smears alone.RESULTS:Malignant tumor cells in the CS material were identified in 43 aspirates (91%). Both the sensitivity and the specificity for TTF‐1 were 100%. The sensitivity for mucin was 60%, and the specificity for mucin was 100%. The diagnoses made on smears were improved by CS in 31 patients (72%), in that more precise separation of subgroups of NSCLC was possible or information on primary tumors was obtained.CONCLUSIONS:The CS technique improved the diagnostic information from FNA in a clinically relevant way. The method is simple, quick, and inexpensive. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.

The challenge of NSCLC diagnosis and predictive analysis on small samples. Practical approach of a working group

“…If no material is left in the syringe for making a clot directly, it is possible to make a clot from the spread material containing small tissue fragments [59]. These cell blocks should be cut in 2-4 m sections and handled as histological material for ancillary studies (see below) [20].…”

“…PCR can be applied to previously MGG and immunostained specimens, since MGG, Pap and immunocytochemistry does not compromise DNA quality. For enrichment of tumour cells (in cytological as well as histological specimen) for molecular analyses manual macrodissection may be done by marking areas to be scraped off and used (see below) [59].…”

Diagnosis and Predictive Molecular Analysis of Non–Small-Cell Lung Cancer in the Africa-Middle East Region: Challenges and Strategies for Improvement

“…Both the absolute number of tumour cells as well as the relative proportion of tumour cells should be considered when choosing samples for molecular testing. Manual macrodissection of unstained regions may improve the tumour cell ratio [56]. In rare cases, laser capture microdissection may be used.…”

Subtyping of nonsmall cell lung cancer on cytology specimens: Reproducibility of cytopathologic diagnoses on sparse material

“…In this case a cytoscrape (CS) can be made. CS is a technique that has been shown to improve the diagnostic information from FNA . The utility of the method has been evaluated by assessing the sensitivity and specificity of the method and by quantifying the extra diagnostic information obtained by the method in comparison with information obtained by smears alone.…”

“…CS material stained with thyroid transcription factor‐1 (TTF1) and mucin improved the diagnoses made on smears in 72% of cases. Thus, the accuracy of the test has been proved by providing more precise subtyping of NSCLC or proper identification of primary tumor in cases of metastases to the lung …”