Diagnostic value of clot examination for malignant cells in serous effusions

To assess the diagnostic value of clot examination for satisfactory processing and confirmation of malignancy in serous effusions in routine cytological evaluation and compare the results with those of conventional smear and cell block preparations.

Body cavity fluids (n = 600) received in our laboratory were processed according to a pre-designed protocol for the study as follows: Day1: on receipt of the specimen, smears were made and a cell block was prepared from the sediment. Day2: after overnight sample storage of the remaining specimen at 2-8 degrees C all fluids were examined for the presence of a clot at the bottom of the container. Fluids in which clot had formed were fixed in formalin. The clot was then placed on a lens paper, wrapped and processed routinely. Diagnostic yields were compared.

In this study, we included 600 cases of serous fluids from pleural, pericardial and peritoneal effusions. In 73% (n = 437) of samples, clot formation was seen, while in 27%, (n = 163) no clot had formed. Routine smear and cell block preparations showed malignant cells in 9.6% (n = 42). However, with the addition of the clot preparation, the number of cases in which atypical/malignant cells were seen increased from 42 to 85 (19.4%), with a P < 0.001. Special stains and immunohistochemistry (IHC) were also performed on clot preparations in 10 difficult cases.

Clot preparation from body cavity fluids on the second day can be used as an adjunct to smear and routine cell block preparation to improve the accuracy and yield of the cytological diagnosis and may also be of great help for special studies such as IHC staining.