Diagnostic utility of immunocytochemistry by using liquid-based cytology (LBC) slides
, 2, 3
Abstract
Introduction. Cytological specimens, such as fine needle aspirations (FNAs) and exfoliative cytology samples, are minimally invasive options for diagnostic purposes. Liquid-based cytology (LBC), originally designed for cervical cytology, has gained prominence as an alternative technique for non-gynecological cytology. Immunocytochemistry (ICC) is an ancillary method used when diagnosis becomes challenging due to morphological overlap or the need for cellular origin clarification. This study aims to assess the diagnostic utility of ICC when applied to LBC slides and evaluate its effectiveness in relation to the waiting (lag) time of residual material.
Materials and methods. A total of 74 cases in which ICC was applied to LBC slides were studied over one year in a reference pathology laboratory (Prof. Dr. Cemil Tascioglu, Pathology Laboratory, City Hospital, Istanbul, Turkey). Cases in which immunohistochemistry (IHC) was performed on formalin-fixed paraffin-embedded cell blocks were excluded. The SurePath PAP method was used for the main LBC cytology slides. For the ICC study, 1–4 PAP-stained LBC slides were obtained from each case’s residual material and stained with a primary antibody.
Results. The positive immunostaining was obtained in 81% of cases. The samples were categorized into groups based on the waiting time of residual LBC material for ICC analysis: 1–5 days, 6–10 days, 11–20 days, and 21–38 days. Comparative analysis revealed a decline in ICC efficacy as the waiting (lag) time increased. Additionally, a statistically significant difference was observed between the 11–20 days and 21–38 days groups (P < 0.05). An analysis of 142 LBC slides stained by ICC revealed that nuclear markers exhibited higher positivity compared to non-nuclear markers, although no significant difference was detected between the two groups.
Conclusions. High positivity rates can be obtained in ICC studies performed on additional slides obtained from residual LBC material within the first 20 days. ICC applied to LBC slides is an important and useful alternative for diagnostic and prognostic markers in cases without a cell block or with a cell block without sufficient number of cells.
Keywords: liquid-based cytologyimmunocytochemistryimmunohistochemistrywaiting (lag) timeSurePath PAP
References
- Kanber Y, Pusztaszeri M, Auger M. Immunocytochemistry for diagnostic cytopathology — a practical guide. Cytopathology. 2021; 32(5): 562–587.
- Rossi ED, Martini M, Capodimonti S, et al. BRAF (V600E) mutation analysis on liquid-based cytology-processed aspiration biopsies predicts bilaterality and lymph node involvement in papillary thyroid microcarcinoma. Cancer Cytopathol. 2013; 121(6): 291–297.
- Rossi ED, Martini M, Straccia P, et al. The potential of liquid-based cytology in lymph node cytological evaluation: the role of morphology and the aid of ancillary techniques. Cytopathology. 2016; 27(1): 50–58.
- Fadda G, Rossi ED, Raffaelli M, et al. Follicular thyroid neoplasms can be classified as low- and high-risk according to HBME-1 and Galectin-3 expression on liquid-based fine-needle cytology. Eur J Endocrinol. 2011; 165(3): 447–453.
- Patarapadungkit N, Jangsiriwitayakorn P, Chaiwiriyakul S, et al. Modified liquid-based cytology technique for immunocytochemistry in effusion specimen. Asian Pac J Cancer Prev. 2019; 20(9): 2611–2617.
- Skoog L, Tani E. Immunocytochemistry: an indispensable technique in routine cytology. Cytopathology. 2011; 22(4): 215–229.
- Lai CR, Pan CC, Tsay SH. Contribution of immunocytochemistry in routine diagnostic cytology. Diagn Cytopathol. 1996; 14(3): 221–225, doi: 10.1002/(SICI)1097-0339(199604)14:3<221::AID-DC5>3.0.CO;2-K.
- Dey P. Automation and Liquid-based Cytology. In: Dey P. ed. Diagnostic Cytology. 3rd Edition. Jaypee Brothers Medical Publishers, New Delhi/London 2022: 312–317.
- Rossi ED, Bizzarro T, Schmitt F, et al. The role of liquid-based cytology and ancillary techniques in pleural and pericardic effusions: an institutional experience. Cancer Cytopathol. 2015; 123(4): 258–266.
- Srebotnik Kirbiš I, Rodrigues Roque R, Bongiovanni M, et al. Immunocytochemistry practices in European cytopathology laboratories-Review of European Federation of Cytology Societies (EFCS) online survey results with best practice recommendations. Cancer Cytopathol. 2020; 128(10): 757–766.
- Pinheiro C, Roque R, Adriano A, et al. Optimization of immunocytochemistry in cytology: comparison of two protocols for fixation and preservation on cytospin and smear preparations. Cytopathology. 2015; 26(1): 38–43.
- Erdogan-Durmus S, Ramazanoglu SR, Barut HY. Diagnostic significance of GATA 3, TTF-1, PTH, chromogranin expressions in parathyroid fine needle aspirations via immuonocytochemical method. Diagn Cytopathol. 2023; 51(7): 449–454.
- Sharma P, Gupta P, Gupta N, et al. Evaluation of the performance of CinTec® PLUS in surepathtm liquid-based cervico-vaginal samples. Turk Patoloji Derg. 2021; 37(1): 32–38.
- Song F, Belinson JL, Yan P, et al. Evaluating the performance of three different cervical cancer screening modalities in a large prospective population-based cohort. J Infect Public Health. 2020; 13(11): 1780–1786.
- Østbye KM, Pedersen MK, Sauer T. Immunocytochemical expression of Ki-67/p16 in normal, atypical, and neoplastic cells in urine cytology using BD SurePath™ as preparation method. Cytojournal. 2019; 16: 26.
- Moon JiH, Nikas IP, Moon KC, et al. Clinical application of the anti-human telomerase reverse transcriptase (hTERT) antibody (SCD-A7) immunocytochemistry in liquid-based urine cytology: A prospective, single institute study. Cancer Med. 2023; 12(9): 10363–10370.
- Tripathy K, Mishra A, Singh AK, et al. Immunocytochemistry using liquid-based cytology: a tool in hormone receptor analysis of breast cancer. J Cytol. 2018; 35(4): 260–264.
- Bjønness-Jacobsen EC, Eriksen AK, Hagen VN, et al. The effect of the small amount of formaldehyde in the SurePath liquid when establishing protocols for immunocytochemistry. Cytojournal. 2016; 13: 27.
- Sakabe N, Maruyama S, Ito C, et al. Effect of liquid-based cytology fixing solution on immunocytochemistry: Efficacy of antigen retrieval in cytologic specimens. Diagn Cytopathol. 2023; 51(9): 546–553.
