Rapid on-site evaluation improves fine-needle aspiration biopsy cell block quality

For fine-needle aspiration (FNA) biopsy, the cell block is used for precision ancillary diagnostic tests and personalized molecular evaluation. It is important to maximize quality cell blocks. Rapid on-site evaluation (ROSE) provides specimen adequacy and guides cell block collection. The study examines how immunohistochemistry (IHC) utilization correlates with cell block quality and the impact of ROSE on cell block quality.

The pathology database identified consecutive FNA biopsy cases with cell blocks. Procedural data and reporting elements were collected including ROSE, adequacy and diagnosis categories, and IHC. Each archived case was reviewed. Cell block cellularity quality scores were categorized as <10%, 10% to 25%, and >25%. Various data points were correlated with the cell block quality score.

The ROSE cohort had a higher group score of 38.8% versus 26.3% for non-ROSE. Low scores on cell block quality were higher with the unsatisfactory and indeterminate groups (85.2% and 78.5%). A higher grouping score was 3× as likely for a satisfactory as an unsatisfactory group (46.5% versus 14.8%). Positive cases with IHC had higher cell block quality scores compared with those without IHC (56.7% versus 33.2%).

It is important for pathologists to contribute to improving FNA biopsy cell block quality. This series shows that higher cell block quality provides better utilization for IHC assessment and for IHC testing in positive diagnostic category cases. Providing ROSE service can improve cell block quality and an assurance of a satisfactory FNA biopsy significantly contributes to improved cell block quality.