Sensitivity and specificity of cell block method of transthoracic fine needle aspiration in diagnosis of lung cancer

Main Article Content

Yusup Subagio Sutanto
Nur Santi
Brian Wasita
Ana Rima
Hendra Kurniawan

Abstract

Background
Lung cancer is still the main cause of cancer deaths. The high lung cancer mortality rate is caused by a diagnosis factor or therapy selection. The cell block cytology technique using fine needle aspiration (FNA) samples can provide immunocytochemical material that plays an important role in the differential diagnosis of lung cancer subtypes and in determining immunotherapy administration. This study aimed to determine the sensitivity and specificity of transthoracic FNA (TTFNA) cell block cytology in comparison with bronchial washing smears and TTFNA smears in diagnosing lung cancer.


Methods
This was a cross-sectional diagnostic study involving 26 subjects. All subjects had undergone bronchial washing and CT scan-guided fine needle aspiration followed by cell block preparation. Both direct FNA smears and cell blocks are useful in the diagnostic work-up of patients. Comparative statistical analysis of TTFNA cell block versus bronchial washing smear and TTFNA smear cytology was carried out using the McNemar test.


Results
Lung cancer was found in 15 patients (57.7%) using the TTFNA cell block technique. The sensitivity and specificity of the TTFNA cell block technique were 85.7% and 75%, respectively. There was no difference in the positivity value between TTFNA cell block technique of bronchial wash smear technique, and TTFNA smear on lung cancer diagnosis (p>0.05).


Conclusions
Transthoracic fine-needle aspiration in combination with the cell block technique has good sensitivity and specificity. The TTFNA can be used for immunocytochemical examinations in lung cancer diagnosis and therapy. This approach is valuable for providing individualized treatment and prognostic evaluations.

Article Details

How to Cite
Sutanto, Y. S., Santi, N. ., Wasita, B. ., Rima, A. ., & Kurniawan, H. . (2021). Sensitivity and specificity of cell block method of transthoracic fine needle aspiration in diagnosis of lung cancer. Universa Medicina, 40(2), 130–137. https://doi.org/10.18051/UnivMed.2021.v40.133-140
Section
Original Articles

References

Kossakowski CA, Morresi-Hauf A, Schnabel PA, Eberhardt R, Herth FJF, Warth A.. Preparation of cell blocks for lung cancer diagnosis and prediction: protocol and experience of a high-volume center. Respiration 2014;87:432-38.doi: 10.1159/000357068.

Dong Z, Li H, Zhou J, Zhang W, Wu C. The value of cell block based on fine needle aspiration for lung cancer diagnosis. J Thorac Dis 2017;9:2375–82. doi: 10.21037/jtd.2017.07.912017;9(8):2375–82.

Malapelle U, Iaccarino A, Rossi A. Cytology versus histology for programmed death-ligand 1 expression evaluation in the landscape of non-small cell lung cancer patients selection for immunotherapy. Transl Lung Cancer Res 2018;7(Suppl 3):S221–4. doi: 10.21037/tlcr.2018.08.09.

Sung S, Heymann JJ, Crapanzano JP, et al. Lung cancer cytology and small biopsy specimens: diagnosis, predictive biomarker testing, acquisition, triage, and management. J Am Soc Cytopathol 2020;9:332–45. doi: 10.1016/j.jasc.2020.04.014.

Tomar V, Vijay N, Nuwal P, Dixit R. Comparative study of bronchoalveolar lavage, bronchial brushing, and FNAC in diagnosing malignant neoplasms of lungs. J Cytol 2016;33:210–3. doi: 10.4103/0970-9371.190448.

Khan S, Omar T, Michelow P. Effectiveness of the cell block technique in diagnostic cytopathology. J Cytol 2012;29:177–82. doi: 10.4103/0970-9371.101167.

Yang W, Jiang H, Khan AN, et al. Transthoracic needle aspiration in solitary pulmonary nodule. Transl Lung Cancer Res 2017;6:76–85. doi: 10.21037/tlcr.2017.02.03.

Santoshpawar, Sameer M, Manishaahuja, Amitapatil. Sensitivity and specificity of cell mlock method in diagnosis of lung malignancies. IOSR J Dent Med Sci 2016;15:86–99. doi: 10.9790/0853-1504018699.

Vural G. Transthoracic fine-needle aspiration biopsy cytology of pulmonary lesions. Euroasia J Math Eng Nat Med Sci 2020;7:55–62. doi: 10.38065/euroasiaorg.214.

Abdulhameed T, Omer J, Ali S. Cell blocks histopathology versus FNA cytology in diagnosis of primary malignant lung mass: a comparative study. Zanco J Med Sci 2017;21:1601–7. doi: 10.15218/zjms.2017.009.

Kakodkar UC, Vadala R, Mandrekar S. Utility of cell-block of bronchial washings in diagnosis of lung cancer- a comparative analysis with conventional smear cytology. Clin Diagn Res 2016; 10: OC25–8.doi: 10.7860/JCDR/2016/15911.7634.

Shivakumarswamy U, Arakeri SU, Karigowdar MH. Diagnostic utility of the cell block method versus the conventional smear study in pleural fluid cytology. J Cytol 2012;29:11-5. doi: 10.4103/0970-9371.93210.

Acharya VK, Unnikrishnan B, Shenoy A, Holla R. Utility of various bronchoscopic modalities in lung cancer diagnosis. Bronchoscopy in lung cancer diagnosis. Asian Pac J Cancer Prev 2017;18:1931–6. doi: 10.22034/APJCP.2017.18.7.1931.

Indonesian Lung Doctors Association. Non-small cell carcinoma type lung cancer. Jakarta: PDPI; 2017. p. 1–29.

Li M, Sundararajan R. Gender and age analysis of lung cancer in Australia. Gen Med (Los Angel) 2017;5: 299. doi: 10.4172/2327-5146.1000299.

Raiza D, Al E. Efficacy of bronchial wash and brush cytology in the diagnosis of lung cancers. Int J Heal Res Mod Integr Med Sci 2014;2:816–20.

Cheng TD, Cramb SM, Baade PD, Youlden DR, Reid ME NC. The international epidemiology of lung cancer: latest trends, disparities, and tumor characteristics. J Thorac Oncol 2016;11:1653–71. doi: 10.1016/j.jtho.2016.05.021.

Cruz CSD, Tanoue LT, Matthay RA. Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med 2011;32:605–44. doi: 10.1016/j.ccm.2011.09.001.

Tomita M, Ayabe T, Nakamura K. Low body mass index is an independent predictive factor after surgical resection in patients with non-small cell lung cancer. Asian Pacific J Cancer Prev 2017;18:3353–6. doi: 10.22034/APJCP.2017.18.12.3353.

Jusuf A, Hudoyo A, Andriani R IR. Diagnosis of lung cancer. In: Jusuf A, editor. Basic diagnosis of lung cancer. 1 st ed. Jakarta: UI Publishing; 2017. p.127–68.

Giti R, Hosseinzadeh M. Efficacy of bronchial washing and brushing cytology in the diagnosis of non-neoplastic lung diseases. Acta Med Iran 2017;55:636–41.

Takigawa N, Ochi N, Yamane H. Histology versus cytology: PD-L1 testing in non-small cell lung cancer. Transl Lung Cancer Res 2018;7(Suppl 3):S225-7. doi: 10.21037/tlcr.2018.08.08.

Torous VF, Rangachari D, Gallant BP, Shea M, Costa DB, VanderLaan PA. PD-L1 testing using the clone 22C3 pharmDx kit for selection of patients with non–small cell lung cancer to receive immune checkpoint inhibitor therapy: are cytology cell blocks a viable option? J Am Soc Cytopathol 2018;7:133–41. doi: 10.1016/j.jasc.2018.02.003.