Role of cell block technique as a novel diagnostic approach in odontogenic cysts and ameloblastomas of the jaw region

Purpose To systematically review (SR) and critically appraise studies that investigated the diagnostic capability of fine‐needle aspiration cytology (FNAC) in the assessment of intraosseous lesions of the jaws. Methods Six main electronic databases and three gray literature databases were searched aiming diagnostic studies, which were selected in a two‐phase process. Risk of bias (RoB) of included studies was assessed using the Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies. Results A total of eight articles were included, of which six evaluated the FNAC smear technique exclusively, one assessed both smear and cell‐block techniques, while one investigated only the cell‐block technique. With regard to the FNAC smear technique, from 134 benign lesions investigated, concordance with the histopathological diagnosis was achieved in 64.17% of cases. In addition, considering the 32 malignant lesions assessed through this technique, concordance with histopathology was achieved in all cases. Regarding the cell‐block technique, only benign lesions (n = 40) were evaluated in the included studies, in which the concordance rate with histopathology was of 77.5%. The overall RoB judgment was “at risk of bias” for seven included studies mostly due to lack of information or reportedly absence of blinding of evaluator. Conclusions Within the limitations of this SR, FNAC presented modest to satisfactory diagnostic capability for the assessment of intraosseous jaw lesions, showing concordance rates higher than 64% for the smear and 77% for the cell‐block technique. Also, considerably high concordance rates were found for the assessment of malignant lesions regarding FNAC smear technique.

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Diagnostic capability of fine‐needle aspiration cytology in assessment of intraosseous lesions of the jaws: A systematic review

Pilati

Santos

Melo

et al. 2020

Diagnostic Cytopathology

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Cell‐block as ancillary tool for the diagnosis of cystic and cyst‐like jaw lesions

Melo

Mello

Mesquita

et al. 2020

Diagnostic Cytopathology

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BackgroundThe cell‐block technique is a cytological diagnostic method that decreases cellular dispersion; however, its usefulness regarding intraosseous lesions is underexplored. Therefore, this study aimed to assess the diagnostic usefulness of cell‐block for cystic and cyst‐like jaw lesions.MethodsIndividuals with cystic or cyst‐like jaw lesions who underwent aspiration biopsy were considered eligible. Aspiration of luminal content was prepared and processed by the cell‐block technique. Cytological evaluations were blindly performed by two trained PhD students (in a single evaluation) and one oral and maxillofacial pathologist (OMP). Cohen's kappa statistic was used to measure inter‐rater agreement.ResultsThe sample was composed of 52 lesions, represented by 25 radicular cysts (RC), 17 odontogenic keratocysts (OKC), 5 idiopathic bone cavities (IBC), and 5 unicystic ameloblastomas (UA). The kappa coefficient of cell‐block compared to histopathological diagnosis was 0.390 (95% confidence interval [95%CI], 0.195‐0.585) for PhD students and 0.612 (95%CI, 0.433‐0.791) for the OMP. The highest concordance rates between cell‐block and histopathological diagnosis were observed for RC (PhD = 76.0%; OMP = 80.0%) and OKC (PhD = 58.8%; OMP = 76.5%). Conflicting results were found regarding IBC (PhD = 40.0%; OMP = 80.0%) and UA, that presented the overall lowest concordance rates (PhD = 20.0%; OMP = 40.0%).ConclusionThe cell‐block technique presented a high diagnostic usefulness for detecting RC and OKC and, if associated with clinical and radiographic characteristics, might be sufficient for final diagnosis of these diseases. Regarding IBC and UA, an analysis with a higher number of cases is recommended to determine the true usefulness of the cell‐block as ancillary tool for the diagnosis of these lesions.

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Ameloblastoma diagnosis by fine‐needle aspiration cytology supplemented by cell block samples

Zaidi

Srinivasan

Rajwanshi

et al. 2020

Diagnostic Cytopathology

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Ameloblastomas are rarely encountered in clinical practice, accounting for only 1% of tumors and cysts of the jaw although they are one of the most common odontogenic neoplasms. The cytological features are described in a few case reports only. The aim of this study was to describe the morphological features of ameloblastoma in fine‐needle aspiration cytology (FNAC) and highlight the contribution of cell blocks in their diagnosis. Three cases of ameloblastoma diagnosed on FNAC (FNAC) with cell block samples were retrieved and evaluated in detail. Radiological correlation was performed in three cases. Follow‐up histopathology of the resected specimen was available in two cases. Cytology smears showed clusters of basaloid cells with high nucleocytoplasmic(N/C) ratio and dense chromatin. Focal squamoid differentiation was present in one case and cystic change predominated in one case. The characteristic morphology of the tumor was better appreciated on cell block section with cribriform and trabecular arrangement of tumor cells with peripheral nuclear palisading with foci of squamoid differentiation and cystic change. Cell blocks from aspirates act as mini‐biopsies and contribute to accurate diagnoses of ameloblastomas of the mandible, thereby emphasizing their contribution to the proper management of these uncommon neoplasms.

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Role of cell block technique as a novel diagnostic approach in odontogenic cysts and ameloblastomas of the jaw region

Cited by 5 publications

References 4 publications

Diagnostic capability of fine‐needle aspiration cytology in assessment of intraosseous lesions of the jaws: A systematic review

Diagnostic capability of fine‐needle aspiration cytology in assessment of intraosseous lesions of the jaws: A systematic review

Cell‐block as ancillary tool for the diagnosis of cystic and cyst‐like jaw lesions

Ameloblastoma diagnosis by fine‐needle aspiration cytology supplemented by cell block samples

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