The Clinical Value Of Cell Block In Pleural Effusion

Objective: In this paper,through a retrospective analysis the data of 59 patients with malignant pleural effusion who were diagnosed by the cell block section which combined immunohistochemistry staining. To investigate the clinical value of cell block in diagnosis of malignant plerual effusion and primary lesion.The aim is to illustrate the clinical value of cell block with the actual case, In order to further vigorously promote this technology in hospitals.Method: 1. Patients with pleural effusion are selected a pleural aspiration site by B ultrasound. Then through the improved central venous catheter drainage of pleural effusion puncture,Drainage of pleural effusion in 500-1000 ml to a sterile drainage bag. 2.50ml-100 ml pleural effusion is drew by sterile syringes and then examined for liquid based cytology.3.The drainage bag was set aside in the pollution area for 2-6hours, if the clot was formed,the cell block was removed and placed in 10% formalin.If the cell block is not formed, The supernatant fluid of bag was discarded,then 1-2ml fresh blood of patients was dropped into the remaining fluid,then the mixture was set aside for 0.5 hour, If gelatinous clot was formed,the clot was removed and placed in 10% formalin.The specimens were sent to the pathology department,embedded in paraffin and cut into sections.The sections were stained with hematoxylin-eosin(HE) and immunohistochemistry. 4.If patients with lung adenocarcinoma are not obtained histological specimen,the cell block section can be used for EGFR gene test.Results: 1.Complications of pleural puncture catheter drainage Among 59 patients,They were underwent the improved central venous catheter drainage of pleural effusion puncture, one case complicated with hemorrhage,one case complicated with Pneumothorax, One case complicated with pleural reaction. Those patients were not given special treatment.There were no catheter related infections. 2.Diagnosis of malignant pleural effusion 59 patients who had malignant pleural effusion were diagnosed by cell block section,The primary tumors of 50 patients were conformed by invasive examination,such as Thoracoscopy、Percutaneous pleural biopsy 、bronchoscope、Gastroscop、Colonoscope and so on.9 patients did not make invasive examination who have absolute or relative contraindications of invasive examination.3.Methods of obtaining cell block specimens 59 patients with a total of 66 specimens were submitted,58(87.9%) specimens were obtained by natural sedimentation.8(12.1%)specimens were obtained by Plasma coagulation method. 4.The diagnosis rate of submitted specimen 59 patients with a total of 66 specimens were submitted. The first positive diagnosis was made on the initial specimen in 53patients(89.8%), on the second in 5 patients(8.5%), the third in1 patient(1.7%). 5.The result of cell block cytospin HE staining 59 patients were diagnosed with malignant pleural effusion,46(78.0%) specimens were reported as malignancy,2(3.4%) specimens were reported as Suspicious for malignancy,11(18.6%) specimens were reported as Atypical cells.6.Comparison the detection rate of cell block section and cytological smear in detecting malignant tumor cells 59 specimens contracted malignant pleural effusion as a result,38 cases were submitted cytological smear at the same time. The detection rate of cell block cytospin HE stain was 78.9%(30/38).The detection rate of cytological smear HE stain was 39.5%(15/38).There is statistically significant difference between the two techniques(χ2=10.31,P<0.05),The detection rate of cell block section HE stain is high.7.The results of cell block cytospin immunohistochemical staining In 59 patients,52 cases(88.1%) showed adenocarcinoma,1 case(1.7%)showed squamous cell carcinoma,1case(1.7%) showed small cell carcinoma,4(6.8%) cases showed mesothelioma.1(1.7%)case showed malignancy(type unspecified).Combined with the clinical date, Specific classification is as follows 1)52 cases of adenocarcinoma :39(75.0%) cases were due to metastatic lung adenocarcinoma;4(7.7%) cases were diagnosed metastatic ovarian; 4(7.7%) cases were diagnosed metastatic gastric adenocarcinoma;1(1.9%)case were diagnosed metastatic rectal cancer;1(1.9%) case were diagnosed metastatic colon cancer;1 case were diagnosed metastatic duodenal cancer; 1(1.9%)case was suspected metastatic pancreatic cancer;1(1.9%) case was diagnosed metastatic adenocarcinoma,but the primary lesion was not be identified.2)1 case was diagnosed metastatic squamous cell carcinoma of the lung.3)1 case was diagnosed small cell lung cancer.4)4 cases were malignant pleural mesothelionma.5)1 case was diagnosed metastatic kidney cancer, but the type was not unspecified.8.EGFR gene test of cell block: Three cases which were diagnosed lung adenocarcinoma were detected EGFR gene test,EGFR gene test showed positive in one case, The other two cases showed negative.Conclusion: 1.The improved central venous catheter drainge is a simple、noninvasive technology which causes less complications and benefits diagnosis、treatment and the recovery of complications,such as hemothorax 、Pneumothorax and so on.2.The cell block technique has uniquely diagnostic advantage in patients who have contraindications of invasive examination,such as acute pulmonary embolism,severe cardiopulmonary underlying disease,bad situation and so on. This technique may be the only opportunity to obtain pathologic diagnosis for those patients.3.If it can not obtain tumor tissues from patients with lung adenocarcinoma,cell block can be substitutes for tumor tissues in EGFR mutation test,in order to guide targeted therapy.4.In order to improve the diagnostic rate of the malignant pleural effusion,We recommend submitting two cell blocks,If negative results were obtained by two specimens,we don’t recommend submitting other specimen.But if patients have contraindications of invasive examination,Three or more specimens should be submitted,in order to obtain the diagnosis.5.The detection rate of cell block section HE stain is superior for cytological smear HE stain in detecting tumor cells.6.When cell block combined immunohistochemistry staining,it plays an important role in the diagnosis of malignant pleural effusion,not only can confirm the diagnosis and the type of tumor cell,but also can confirm primary lesion or narrow the range of primary lesion. 7.Sensitive and specific for the diagnosis of malignant mesothelionma is not clear. 8.If malignant tumor is composite type,differential diagnostic value of the cell blcok technique is not clear. 9.Malignant Pleural effusion in patients with a known cancer history,The cell block technique helps diagnosis of uncovering hidden primary tumor from other parts of the body. 10.The cell block technique is simple and has a high yield for malignant effusion,Not only can be used in the differential diagnosis of pleural effusion,It can also be applied to other serous cavity effusion.This method should be spread in hospitals.