الفهرس 
Introduction and Aim of the WorkOnly 14 pages are availabe for public view
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Abstract
Malignant pleural effusions represent common and debilitating complications of a wide array of malignancies; virtually any malignant cell type can cause a MPE with metastatic adenocarcinoma being the most common tumor type. The term MPE defines effusions that result from direct infiltration of the pleura by cancer cells.
Cytopathology is one of the most important ways for diagnosis of serous effusions, as it can give a clue for the diagnosis by a simple needle prick, which is considered an easy, cheap and least invasive for the patient. So increasing the diagnostic accuracy of fluid cytology is of great importance.
The diagnostic performance of the cytologic study of the fluid may be attributed to the fact that the cell population present in sediment is representative of a much larger surface area than that obtained by needle biopsy.
This study aimed to improve the technique of cytological examination and its diagnostic yield, and to narrow the gap between the clinician perspectives and the actual cytological findings.
This study included 140 cases of pleural effusion samples sent to the Pathology Laboratory from Cardiothoracic Surgery Department, Sohag University Hospitals, during the period from February 2016 to June 2017.
Fluid samples and tissue biopsies were obtained through medical thoracoscopy. Submission of 30 ml sample is cost-effective without any sacrifice of diagnostic yield. Slide smears were stained by H&E and Papanicolaou stain.
Both fluid cytology smears and cellblocks for all studied cases were examined and the results were correlated to the histopathological examination results as a gold standard.
Our study included 62 females and 74 males, with age range between 14 and 90 with a median of 55. Left side effusion was present in 64 cases, right pleural effusion was present in 69 cases and bilateral pleural effusion was present in 7 cases.
Examination of fluid cytology smears revealed that there were 109 inflammatory cases, 11 atypical cases, 6 cases suspicious for malignancy and 14 frankly malignant cases. Cellblock examination revealed that there were 106 inflammatory cases, 11 atypical cases, 3 cases suspicious for malignancy and 20 frankly malignant cases
Radiological examination of 117 cases revealed that 96 patients were negative for malignancy, whereas 21 patients were positive for malignancy.
The Percent agreement was equal to 73.50% comparing the results of smear examination with results of radiological examination for the 117 patients for whom radiological examination was done.
The Percent agreement was equal to79.49, comparing the results of cellblock examination with the results of radiological examination for the 117 patients for whom radiological examination was done.
We compare the results of smear examination with the results of biopsy examination, which is the gold standard for diagnosis in the 84 patients from whom biopsy was taken. This showed that the sensitivity was 66.67%, specificity was 95.24%, the positive predictive value was 82.35%, the negative predictive value was 89.55% and the accuracy was 80.95%, with Percent agreement equal to 88.10%,
On the other hand, we compare the results of cellblock examination with results of biopsy examination as a gold standard for diagnosis in the 84 patients who had biopsy. This showed that the sensitivity was 90.48%, the specificity was 96.83%, the positive predictive value was 90.48%, the negative predictive value was 96.83% and the accuracy was 93.65%, with Percent agreement equal to 95.24%,
Simultaneous use of the cellblock technique and smear examination increased the diagnostic accuracy by 12.7%. In addition, cellblock technique provided better architecture, cellular details and higher cellularity. It also increased greatly the sensitivity of the diagnosis to become 90.48% compared to 66.67% for using smear alone. With the use of paraffin block technique additional sections could be obtained which facilitates the use of special stains and/or immunohistochemical studies later on.
With the use of cellblock examination additional 6 cases of malignant fluids were diagnosed, while 3 cases excluded compared to conventional smear study. Comparing the results of smear examination with the results of cellblock examination for all 140 studied cases revealed that the Percent agreement was equal to 87.86%.
So it’s recommended to apply cellblock technique whenever possible to help in diagnosis of difficult cases, give better cytomorphological details, thus increasing the sensitivity, and provides easier application of special stains and IHC which could be of value in diagnosis and research studies.
Conclusions
1. Cellblock preparation from pleural fluid samples is very useful adjunct for cytopathological examination in addition to cytological smear examination.
2. The method is simple, reproducible and readily adaptable in routine hospital laboratory. It concentrates the cellular material in one small area that could be evaluated easily at a glance with all cells lying in the same focal plane of microscope.
3. It preserves architectural pattern like cell balls, papillae and three-dimensional clusters, which may help to identify the primary site of malignancy in metastatic effusions.
4. It shows intact cell membranes and crisp chromatin details.
5. It also provides multiple sectioning of the same material for special stains and immunohistochemistry that could be of value for diagnosis and research studies.
Recommendations
1. We recommend the use cellblock technique in addition to the conventional smear whenever possible to get results that are more accurate for cytological evaluation of cases of pleural effusion.
2. Cutting serial slide sections from cellblock for immunohistochemical evaluation is advised to confirm the diagnosis and help research studies.
3. Finally, it is advised to use the automated cellblock technique, as it is easier and gives more accurate results than the manual methods.