title: The state of cell block variation and satisfaction in the era of molecular diagnostics and personalized medicine.
abstract: BACKGROUND
  In the recent past, algorithms and recommendations to standardize the morphological, immunohistochemical and molecular classification of lung cancers on cytology specimens have been proposed, and several organizations have recommended cell blocks (CBs) as the preferred modality for molecular testing. Based on the literature, there are several different techniques available for CB preparation-suggesting that there is no standard. The aim of this study was to conduct a survey of CB preparation techniques utilized in various practice settings and analyze current issues, if any.
  
  
  METHODS
  A single E-mail with a link to an electronic survey was distributed to members of the American Society of Cytopathology and other pathologists. Questions pertaining to the participants' practice setting and CBs-volume, method, quality and satisfaction-were included.
  
  
  RESULTS
  Of 95 respondents, 90/95 (94%) completed the survey and comprise the study group. Most participants practice in a community hospital/private practice (44%) or academic center (41%). On average, 14 CBs (range 0-50; median 10) are prepared by a laboratory daily. Over 10 methods are utilized: Plasma thrombin (33%), HistoGel (27%), Cellient automated cell block system (8%) and others (31%) respectively. Forty of 90 (44%) respondents are either unsatisfied or sometimes satisfied with their CB quality, with low-cellular yield being the leading cause of dissatisfaction. There was no statistical significance between the three most common CB preparation methods and satisfaction with quality.
  
  
  CONCLUSIONS
  Many are dissatisfied with their current method of CB preparation, and there is no consistent method to prepare CBs. In today's era of personalized medicine with an increasing array of molecular tests being applied to cytological specimens, there is a need for a standardized protocol for CB optimization to enhance cellularity.
authors.affiliation: Address: Department of Pathology and Cell Biology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Crapanzano
authors.affiliation: Address: Department of Pathology and Cell Biology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Jonas J
authors.initials: JJ
authors.lastname: Heymann
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Monaco
authors.affiliation: Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA.
authors.forename: Aziza
authors.initials: A
authors.lastname: Nassar
authors.affiliation: Address: Department of Pathology and Cell Biology, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA.
authors.forename: Anjali
authors.initials: A
authors.lastname: Saqi
keywords: Cell block; cytopathology; fine-needle aspiration; lung cancer; molecular testing; personalized medicine