Collection and processing of effusion fluids for cytopathologic evaluation

Abstract

Accumulation of fluid in serous cavities as effusions may have to be drained for therapeutic and diagnostic indications. As compared to many other procedures, the technicality of paracentesis procedures is relatively easy. As a result, effusion fluids comprise a significant proportion of specimens in most of the laboratories, including those in community settings. Because of relative complexities in the cytopathologic evaluation of effusion fluids, application of appropriately standardized protocol is critical for achieving optimum results by applying standardized steps from handling of specimens during the initial stages of collection to the final interpretation phase. Understanding various limitations and challenges during collection and processing phases by all the personnel involved, including clinicians, pathologists, and technologists is critical for optimum diagnostic yield. This review highlights various cytopreparatory techniques applicable to effusion cytology in one place. It is organized by projecting the details predominantly in the form of different tables and figures including summary of the recommended protocols with reagents and stains used. Also included is a sample of cytopathology report based on the approach discussed in this series.

Role of cytoblock on pleural effusion for diagnosis of malignant disease

“…However, for reporting effusion cytology specimens, there is no consistent and reproducible reporting system. 19,20 In our study, we aimed to contribute to the importance of this technique in the diagnosis of pulmonary lesions and pleural lesions, as well as in the diagnosis of metastatic tumors, especially those that are still undiagnosed, those that do not produce lesions detectable in the lungs, and those that are clinically unremarkable. Furthermore, we aimed to examine the impact of this approach in the detection of tumor recurrence with previously known malignant disease.…”

“…To the Indian guidelines of 2020 and a recent paper by Shidham, among malignant effusions, cytology is helpful in determining the exact type, site, and stage of the tumor. However, for reporting effusion cytology specimens, there is no consistent and reproducible reporting system 19,20 . In our study, we aimed to contribute to the importance of this technique in the diagnosis of pulmonary lesions and pleural lesions, as well as in the diagnosis of metastatic tumors, especially those that are still undiagnosed, those that do not produce lesions detectable in the lungs, and those that are clinically unremarkable.…”

Number Needed to Diagnose in Malignant Ascites: Effects of Volume, Repeating Collection, and Primary Malignancy on Diagnostic Performance in Peritoneal Fluid Cytology

“…NND analysis including only aliquots with multiples within a day more closely reflects the practice where fluids were divided before submission. This may be due to limitations in container size, laboratory protocols, or clinical guidelines in the rate of fluid drainage [15, 16]. In those cases, the diagnostic rate of the first aliquot decreased to 88.9% but normalized to 100% at the fourth aliquot.…”

A comparative study of cytological processing techniques in hemorrhagic effusion

“…Because of numerous technical and quality control issues, it is ideal to have cell-block for immunocytochemistry. [ 19 - 21 ] Smears treated with fixative containing GAA has shown high false positive results on hybrid capture 2 human papillomavirus testing. [ 17 ] Ammonium chloride-based erythrocyte lysing reagent, similar to that used for flow cytometry is relatively simpler and inexpensive without compromising the immunoprofile integrity in preparing cell-block of hemorrhagic effusions.…”

“…[ 17 ] Ammonium chloride-based erythrocyte lysing reagent, similar to that used for flow cytometry is relatively simpler and inexpensive without compromising the immunoprofile integrity in preparing cell-block of hemorrhagic effusions. [ 19 - 21 ]…”