title: Effective clinical practices for improved FNA biopsy cell block outcomes.
abstract: BACKGROUND
  Cell blocks are critically important in fine-needle aspiration (FNA) biopsies and the increasing requirements for personalized medicine testing further highlight their value. When a cell block is inadequate, it can necessitate additional procedures. The objective of the current study was to measure the impact and outcome of dedicated aspirate pass techniques and slide cellularity on cell block quality.
  
  
  METHODS
  Over a 6-month period, all FNA biopsy cases with cell blocks were identified. Procedural data including the number of dedicated aspirate passes were recorded. Individual cases were retrospectively reviewed and scored for multiple endpoints, including aspirate smear cellularity and cell block quality.
  
  
  RESULTS
  A total of 605 FNA biopsy and cell block cases were identified. The cell block quality score demonstrated a progressive improvement with an increasing number of dedicated biopsies. The performance of a single dedicated biopsy demonstrated a higher percentage of intermediate to high cell block quality scores in comparison with none (+12.1%; P = .0142). The performance of 3 dedicated biopsies demonstrated a higher percentage of intermediate to high cell block quality scores in comparison with a single pass (+13.5%; P = .0138). An intermediate-quality to high-quality terminal aspirate smear was more likely to have a high cell block quality score (+31.6%; P = .0001).
  
  
  CONCLUSIONS
  Performing at least 1 dedicated FNA biopsy pass was found to improve cell block quality and multiple dedicated biopsies resulted in nearly one-half having a higher quality score. A high-cellularity terminal FNA biopsy smear contributed significantly to obtaining a high-quality cell block. Performing dedicated FNA biopsies and the use of high-quality aspirate smears are effective clinical practices for improving cell block outcomes.
authors.affiliation: Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Collins
authors.affiliation: Department of Cytology, Barnes-Jewish Hospital, St. Louis, Missouri.
authors.forename: Telly C
authors.initials: TC
authors.lastname: Garcia
authors.affiliation: Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
authors.forename: Jena B
authors.initials: JB
authors.lastname: Hudson
mesh_terms: D044963:Biopsy, Fine-Needle / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006652:Histological Techniques; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging / Q000379:methods; D009369:Neoplasms / Q000175:diagnosis / Q000473:pathology*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D016610:Tissue Embedding / Q000379:methods*
keywords: ancillary testing; cell block; cytology; fine-needle aspiration; laboratory management