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.

Keywords:
Liquid-based cytology, Thin-layer fine-needle aspiration, Transbronchial needle aspiration, Sputum, Bronchial wash, Bronchial brush, Bronchoalveolar lavage, Pleural effusion
1.
Fischler DF, Toddy SM: Nongynecologic cytology utilizing the ThinPrep processor. Acta Cytol 1996;40:669-675.
2.
Choi YD, Han CW, Kim JH, Oh IJ, Lee JS, Nam JH, Juhng SW, Park CS: Effectiveness of sputum cytology using ThinPrep method for evaluation of lung cancer. Diagn Cytopathol 2008;36:167-171.
3.
Rana DN, O'Donnell M, Malkin A, Griffin M: A comparative study: conventional preparation and ThinPrep 2000 in respiratory cytology. Cytopathology 2001;12:390-398.
4.
Wang HH, Sovie S, Trawinski G, Garcia LW, Abu-Jawdeh GM, Upton M, Werneke S: ThinPrep processing of endoscopic brushing specimens. Am J Clin Pathol 1996;105:163-167.
5.
Hees K, Lebeau PB: Comparison of conventional and ThinPrep preparations of mucoid cytology samples. Diagn Cytopathol 1995;12:181-185.
6.
Elsheikh TM, Kirkpatrick JL, Wu HH: Comparison of ThinPrep and cytospin preparations in the evaluation of exfoliative cytology specimens. Cancer 2006;108:144-149.
7.
Gabriel C, Achten R, Drijkoningen M: Use of liquid-based cytology in serous fluids: a comparison with conventional cytopreparatory techniques. Acta Cytol 2004;48:825-835.
8.
Moriarty AT, Schwartz MR, Ducatman BS, Booth CN, Haja J, Chakraborty S, Williamson B; College of American Pathologists: A liquid concept - do classic preparations of body cavity fluid perform differently than ThinPrep cases? Observations from the College of American Pathologists Interlaboratory Comparison Program in Nongynecologic Cytology. Arch Pathol Lab Med 2008;132:1716-1718.
9.
Leung CS, Chiu B, Bell V: Comparison of ThinPrep and conventional preparations: nongynecologic cytology evaluation. Diagn Cytopathol 1997;16:368-371.
10.
Konofaos P, Tomos P, Malagari K, Karakatsani A, Pavlopoulos D, Lachanas E, Flessas M, Kostakis A, Karakitsos P: The role of ThinPrep cytology in the investigation of lung tumors. Surg Oncol 2006;15:173-178.
11.
Bavikatty NR, Michael CW: Cytologic features of small-cell carcinoma on ThinPrep. Diagn Cytopathol 2003;29:8-12.
12.
Wallace WA, Monaghan HM, Salter DM, Gibbons MA, Skwarski KM: Endobronchial ultrasound-guided fine-needle aspiration and liquid-based thin-layer cytology. J Clin Pathol 2007;60:388-391.
13.
Kim S, Owens CL: Analysis of ThinPrep cytology in establishing the diagnosis of small cell carcinoma of lung. Cancer 2009;117:51-56.
14.
Gauchotte G, Vignaud JM, Menard O, Wissler MP, Martinet Y, Siat J, Paris C, Clement-Duchene C: A combination of smears and cell block preparations provides high diagnostic accuracy for endobronchial ultrasound-guided transbronchial needle aspiration. Virchows Arch 2012;461:505-512.
15.
Wu GP, Wang EH, Li JH, Fu ZM, Han S: Clinical application of the liquid-based cytological test in cytological screening of sputum for the diagnosis of lung cancer. Respirology 2009;14:124-128.
16.
Chhieng DC, Ko EC, Yee HT, Shultz JJ, Dorvault CC, Eltoum IA: Malignant pleural effusions due to small-cell lung carcinoma: a cytologic and immunocytochemical study. Diagn Cytopathol 2001;25:356-360.
17.
Collins GR, Thomas J, Joshi N, Zhang S: The diagnostic value of cell block as an adjunct to liquid-based cytology of bronchial washing specimens in the diagnosis and subclassification of pulmonary neoplasms. Cancer Cytopathol 2012;120:134-141.
18.
Hou G, Yin Y, Wang W, Wang QY, Hu XJ, Kang J, Wu GP: Clinical impact of liquid-based cytology test on diagnostic yields from transbronchial needle aspiration. Respirology 2012;17:1225-1228.
19.
Ylagan LR, Zhai J: The value of ThinPrep and cytospin preparation in pleural effusion cytological diagnosis of mesothelioma and adenocarcinoma. Diagn Cytopathol 2005;32:137-144.
20.
Curry JL, Wojcik EM: Malignant pericardial effusion with metastatic squamous-cell carcinoma: discordance between ThinPrep and cell-block cytopreparation. Diagn Cytopathol 2003;29:270.
21.
Jing X, Li QK, Bedrossian U, Michael CW: Morphologic and immunocytochemical performances of effusion cell blocks prepared using 3 different methods. Am J Clin Pathol 2013;139:177-182.
22.
Gong Y, Sun X, Michael CW, Attal S, Williamson BA, Bedrossian CW: Immunocytochemistry of serous effusion specimens: a comparison of ThinPrep versus cell block. Diagn Cytopathol 2003;28:1-5.
23.
Kawahara A, Taira T, Abe H, Watari K, Murakami Y, Fukumitsu C, Takase Y, Yamaguchi T, Azuma K, Akiba J, Ono M, Kage M: Fixation effect of SurePath preservative fluids using epidermal growth factor receptor mutation-specific antibodies for immunocytochemistry. Cancer Cytopathol 2014;122:145-152.
24.
Dejmek A, Zendehrokh N, Tomaszewska M, Edsjo A: Preparation of DNA from cytological material: effects of fixation, staining, and mounting medium on DNA yield and quality. Cancer Cytopathol 2013;121:344-353.
25.
Malapelle U, de Rosa N, Rocco D, Bellevicine C, Crispino C, Illiano A, Piantedosi FV, Nappi O, Troncone G: EGFR and KRAS mutations detection on lung cancer liquid-based cytology: a pilot study. J Clin Pathol 2012;65:87-91.
26.
Malapelle U, de Rosa N, Bellevicine C, Rocco D, Vitiello F, Piantedosi FV, Illiano A, Nappi O, Troncone G: EGFR mutations detection on liquid-based cytology: is microscopy still necessary? J Clin Pathol 2012;65:561-564.
27.
Lv M, Wu MZ, Zhao YJ, Yang DI, Wang EH, Wu GP: Expression and clinical significance of lung-specific X protein mRNA in bronchial brushing specimens from patients with or without lung cancer. Respirology 2011;16:1076-1080.
28.
Zardawi IM, Blight A, Ling S, Braye SG: Liquid-based vs. conventional cytology on respiratory material. Acta Cytol 2009;53:481-483.
© 2014 S. Karger AG, Basel
2014
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.