Importance of the Cell Block Technique in Diagnosing Patients with Non-Small Cell Carcinoma Accompanied by Pleural Effusion

  • Ugurluoglu, Ceyhan (Department of Pathology Disease, Selcuk University Medicine Faculty) ;
  • Kurtipek, Ercan (Department of Chest Disease, Konya Training and Research Hospital) ;
  • Unlu, Yasar (Department of Pathology Disease, Konya Training and Research Hospital) ;
  • Esme, Hidir (Department of Thoracic Surgery, Konya Training and Research Hospital) ;
  • Duzgun, Nuri (Department of Thoracic Surgery, Konya Training and Research Hospital)
  • Published : 2015.04.14


Background: Cytological examination of pleural effusions is very important in the diagnosis of malignant lesions. Thoracentesis is the first investigation to be performed in a patient with pleural effusion. In this study, we aimed to compare traditional with cell block methods for diagnosis of lung disease accompanied by pleural effusion. Materials and Methods: A total of 194 patients with exudative pleural effusions were included. Ten mililiters of fresh pleural fluid were obtained by thoracentesis from all patients in the initial evaluation. The samples gathered were divided to two equal parts, one for conventional cytological analysis and the other for analysis with the cell block technique. In cytology, using conventional diagnostic criteria cases were divided into 3 categories, benign, malignant and undetermined. The cell block sections were evaluated for the presence of single tumor cells, papillary or acinar patterns and staining with mucicarmine. In the cell block examination, in cases with sufficient cell counts histopathological diagnosis was performed. Results: Of the total undergoing conventional cytological analyses, 154 (79.4%)were reported as benign, 33 (17%) as malignant and 7 (3.6%) as suspicious of malignancy. With the cell block method the results were 147 (75.8%) benign, 12 (6.2%) metastatic, 4 (2.1%) squamous cell carcinoma, 18 (9.3%) adenocarcinoma, 5 (2.6%) large cell carcinoma, 2 (1%) mesothelioma, 3 (1.5%) small cell carcinoma, and 3 (1.5%) lymphoma. Conclusions: Our study confirmed that the cell block method increases the diagnostic yield with exudative pleural effusions accompanying lung cancer.


Non-small cell lung cancer;cell block;pleural effusion;$imm{\ddot{u}}nohystochemistry$


  1. Atalay F, Ernam D, Atikcan S (2001). Lung cancer and pleural effusions. Solunum Hasaliklari, 12, 274-8 (in Turkish).
  2. Basnet S, Talwar OP, (2012). Role of cell block preparation in neoplastic lesions. J Pathol Nepal, 2, 272-6.
  3. Santwani PM, Vachhani JH, (2014). Analysis of diagnostic value of cytological smear method versus cell block method in body fluid cytology: study of 150 cases. Ethiop J Health Sci, 24, 125-1.
  4. Biesterfeld S, Schramm M, Schad A, Pomjanski N, (2014). Pleural effusion cytology of asbestos-associated malignant mesothelioma and lung carcinoma in the diagnosis of occupational diseases by the statutory accident insurance funds. Pneumologie, 68, 270-6.
  5. Carpagnano GE, Costantino E, Palladino GP, et al (2012). Microsatellite alteration sand cell-free DNA analysis: could they increase the cytology sensitivity in the diagnosis of malignant pleural effusion? Rejuvenat Res, 15, 265-3.
  6. Ensani F, Nematizadeh F, Irvanlou G, (2011). Accuracy of immunohistochemistry in evaluation of malignant pleural and peritoneal effusions. Pol J Pathol, 62, 95-0.
  7. Cusumano G, Margaritora S, Porziella V, et al (2007). Malignant pleural effusion. Ann Ital Chir, 78, 389-1.
  8. Dagli AF, Kucuk S, Sezer M, Ucer O, (2011). Cytopathologic diagnosis in pleural effusion and cyto-histopathologic correlation. Turkish J Pathol, 27, 12-6.
  9. Gao BA, Zhou G, Guan L, et al (2014). Effectiveness and safety of diagnostic flexi-rigid thoracoscopy in differentiating exudative pleural effusion of unknown etiology: a retrospective study of 215 patients. J Thorac Dis, 6, 438-3.
  10. Ghosh I, Dey SK, Das A, et al (2012). Cell block cytology in pleural effusion. J Indian Med Associat, 110, 390-6.
  11. Grandhi B, Shanthi V, Rao NM, et al (2014). The diagnostic utility of cell bloc as an adjunct to cytological smears. Int J Med Res Health Sci, 3, 278-4.
  12. Ikeda K, Tate G, Suzuki T, et al (2011). Comparison of immunocytochemical sensitivity between formalin-fixed and alcohol-fixed specimens reveals the diagnostic value of alcohol-fixed cytocentrifuged preparations in malignant effusion cytology. Am J Clin Pathol, 136, 934-2
  13. Koksal D, Demirag F, Bayiz H et al (2013). The cell block method increases the diagnostic yield in exudative pleural effusions accompanying lung cancer. Turk Patoloji Derg, 29, 165-0.
  14. Khan S, Omar T, Michelow P, (2012). Effectiveness of the cell block technique in diagnostic cytopathology. J Cytol, 29, 177-2
  15. Kossakowski CA, Morresi-Hauf A, Schnabel PA, et al (2014). Preparation of cell blocks for lung cancer diagnosis and prediction: protocol and experience of a high-volume center. Respirat, 87, 432-8.
  16. Nance KV, Shermer RW, Askin FB, (1991). Diagnostic efficacy of pleural biopsy as compared with that of pleural fluid examination. Mod Pathol, 4, 320-4.
  17. Mandal SK, Singh TT, Sharma TD, et al (2013). Clinicopathology of lung cancer in a regional cancer center in Northeastern India. Asian Pac J Cancer Prev, 14, 7277-1
  18. Porcel JM, Esquerda A, Vives M, et al (2014). Etiology of pleural effusions: analysis of more than 3,000 consecutive thoracenteses. Arch Bronconeumol, 50, 161-5.
  19. Price BA, Ehya H, Lee JH, (1992). Significance of pericellular lacunae in cellblocks of effusions. Acta Cytol, 36, 333-7.
  20. Rivera MP, Mehta AC, Wahidi MM, (2013). Establishing the diagnosis of lung cancer. diagnosisand management of lung cancer. ACCP evidence-based clinica practice guidelines. Chest, 143, 142-5.
  21. Rodriguez F, Bordens F, Lopez J, (1989). Pleural metastatic tumorsandeffusions. Frequency and pathogenic mechanisms in a post-mortem series. Eur Respir J, 2, 366-9.
  22. Sanz-Santos J, Serra P, Andreo F, et al (2012). Contribution of cell blocks obtained through endobronchial ultrasoundguided transbronchial needle aspiration to the diagnosis of lung cancer. BMC Cancer, 21, 12-34.
  23. Scagliotti G, Brodowicz T, Shepherd FA, et al (2011). Treatmentby- histology interaction analyses in threephase III trials show superiority of pemetrexed in nonsquamousnon-small cell lung cancer. J Thorac Oncol, 6, 64-0.
  24. Shivakumarswamy U, Arakeri SU, Karigowdar MH, et al (2012). Diagnosticutility of the cell block method versus the conventional smear study in pleural fluid cytology. J Cytol, 29, 11-5.
  25. Soini Y, Kinnula V, Kahlos K, et al (2006). Claudins in differential diagnosis between mesothelioma and metastatic adenocarcinoma of the pleura. J Clin Pathol, 59, 250-4.
  26. Wang YX, Chu XY, Sun YE, et al (2007). Clinical pathological study on nodal micrometastases of non-small-cell lung cancer. J Chin Med Assoc, 45, 114-7.
  27. Zhang Y, Yu LK, Lu GJ, et al ( 2014). Prognostic values of VEGF and endostatin with malignant pleural effusions in patients with lung cancer. Asian Pac J Cancer Prev, 15, 8435-0.

Cited by

  1. Cell blocks in cytopathology: An update pp.09565507, 2018,