The Implementation of Liquid-Based Cytology for Lung and Pleural-Based Diseases

Abstract

Objective: First introduced for the processing of cervico-vaginal samples, liquid-based cytology (LBC) soon found application in nongynecological specimens, including bronchoscopic brushings, washings and transcutaneous and transbronchial aspiration biopsy of the lung as well as pleural effusions. This article reviews the existing literature related to these specimens along with the authors' own experience. Study Design: A literature review was conducted through Ovid MEDLINE and PubMed search engines using several key words. Results: Most of the literature is based on data collected through the use of split samples. The data confirms that the use of LBC is an acceptable, and sometimes superior, alternative to the conventional preparations (CP). LBC offers several advantages, including the ability to transport in a stable collecting media, elimination of obscuring elements, ease of screening, excellent preservation, random representative sample, and application of ancillary techniques on additional preparations. Some diagnostic pitfalls related to the introduced artifacts were reported. Conclusion: The utilization of LBC offers many advantages over CP and has a diagnostic accuracy that is equal to or surpasses that of CP. LBC affords a bridge to the future application of molecular and other ancillary techniques to cytology. Knowledge of the morphological artifacts is useful at the early stages of implementation.

Pre-analytical issues in effusion cytology

“…A single prep is considered representative of the sample thus eliminating the need for preparing several slides. In the first author's experience additional slides prepared from the same vial for teaching or research are usually reproducible and consistent with the original slide [14]. It is recommended that a cell block is prepared in conjunction with LBP (reports for TP) this is particularly important because fluids may contain large fragments that may not pass through the filter and are only noticed on the CB [15].…”

Guidelines for the Cytopathologic Diagnosis of Epithelioid and Mixed-Type Malignant Mesothelioma

“…The main obstacles for the diagnosis are: (i) the low yield of the diagnostic cells due to hypocellularity, bleeding or inflammation; (ii) a cytopathologist's lack of experience, and (iii) lack of awareness of this diagnostic possibility. A low yield of diagnostic cells can be circumvented by concentration techniques, such as liquid-based cytology and the cell block technique [15]. …”

Cytomorphologic features of small cell carcinoma of lung in effusion fluid using a liquid‐based cytology technique

“…Architecturally, the patterns of LBC and CCP were similar. Nevertheless, LBC preserved cellular details well enough for diagnosis6,8,11,[15][16][17] and provided superior diagnostic sensitivity 11. Large tight three-dimensional clusters predominated in 11 cases (26.8%).…”