Review
Acta Cytologica
DOI: 10.1159/000489769
Cell Block in Cytological Diagnostics:
Review of Preparatory Techniques
Leena Krogerus a Ivana Kholová b, c
a Department
of Pathology, HUSLAB, Jorvi Hospital, Espoo, Finland; b Department of Pathology, Fimlab Laboratories,
Tampere University Hospital, Tampere, Finland; c Department of Pathology, Faculty of Medicine and Life Sciences,
University of Tampere, Tampere, Finland
Keywords
Cell block · Cytology technique · Cytology
Abstract
Objective: The cell block (CB) technique refers to the pro-
cessing of sediments, blood clots, or grossly visible tissue
fragments from cytological specimens into paraffin blocks
that can be cut and stained by the same methods used for
histopathology. The technique brings additional tissue ar-
chitectural information. CB can be used for ancillary tech-
niques such as immunocytochemistry and molecular tech-
niques. Study Design: We reviewed the literature on the var-
ious preparatory techniques of CBs. Results: There is a wide
range of preparatory techniques for CBs and no golden stan-
dard for CBs exists: tens of methods are used in various insti-
tutions. The majority of the methods are modified in house
techniques with a few commercially available kits. The tech-
niques most commonly used are the plasma/thrombin
method, the agar method, and commercially available His-
togel- and Cellient CB-methods. Dissatisfaction with the cel-
lular yield of the CBs is common. Conclusions: In the CBs, the
cytological material is preserved for future use, which is a
tremendous advantage in the era of targeted therapy and
biobanking. The CB is thus central to the future of cytology:
more can be done with less material and with less invasive-
ness to the patient. © 2018 S. Karger AG, Basel
© 2018 S. Karger AG, Basel
E-Mail karger@karger.com
www.karger.com/acy
Received: March 1, 2018
Accepted after revision: May 3, 2018
Published online: June 15, 2018
Introduction
Doctor Leopold Koss has written: “The cell block tech-
nique should be used for processing all residual material
remaining after completion of cytological preparations.
This material often contains useful information” [1]. Cell
block (CB) refers to the collecting of sediment, blood clots,
or grossly visible pieces of tissue from cytologic specimens
that are processed into paraffin blocks and stained mainly
by hematoxylin-eosin, a stain familiar to all pathologists
[2, 3]. The technique brings an additional structural mor-
phology to cytological specimens: tissue architecture is re-
vealed. Furthermore, the CB can be used for ancillary
techniques such as immunocytochemistry and special
stains. In many laboratories, CBs are used for molecular
techniques such as polymerase chain reaction-based se-
quencing, in situ hybridization and quantitative poly-
merase chain reaction to detect oncogene mutations, gene
fusions, gene copy number gains, and protein overexpres-
sion. CBs are feasible for next generation sequencing with
the advantage of multiple serial sections and standardized
validation in most laboratories for paraffin-embedded
material; nevertheless, suboptimal cellularity is a common
limitation. The recommended cell content is at least 500
tumor cells for the various molecular techniques [3–7].
CBs can be prepared by various techniques [2]. The
main principle in each technique is nevertheless the con-
163.15.154.53 - 6/18/2018 6:28:55 PM
Kaohsiung Medical University Library
Correspondence to: Dr. Ivana Kholová
Department of Pathology, Fimlab Laboratories
Tampere University Hospital, PO Box 66
FI–33101 Tampere (Finland)
Downloaded by:
E-Mail ivana.kholova @ sll.fimnet.fi
centration of cells and their processing into paraffin
blocks. The majority of the methods are modified in-
house techniques with a few commercially available kits
on the market. In the biobanking era, CBs are of para-
mount importance for the biobank storage of cytological
material. Furthermore, in the age of personalized medi-
cine, the metastases are targeted for diagnosis mainly by
fine-needle aspiration (FNA) [7] and CB material can be
the only material available for mutation and drug resis-
tance profiling.
In general, the preparation of CBs may slow down the
otherwise quick flow of cytological diagnostics. Any type
of cytological material, namely, FNAs, liquid-based prep-
arations, brushings, body fluids, and scraped cells are ap-
plicable. Cytological material contains whole, unpro-
cessed cells. CBs cannot be understood as a substitute but
a complimentary to cytological slides.
Each method has its advantages and disadvantages.
What methods to choose from for making a CB depend
on what equipment is available for you and also on the
material itself. If you have a histolab in your vicinity that
can be used without limitations, your approach will be
different than if you only have a cytolab with convention-
al methods to work with. But you will always need a mi-
crotome for sectioning the end product, the blocks. The
present review will cover various published CB prepara-
tion techniques and their feasibility in morphological di-
agnostics and ancillary techniques.
Historical Perspective
CB technique was first reported by Bahrenburg [8]. He
processed the ascitic fluid of 2 patients into histologic sec-
tions by spontaneous clotting, alcohol hardening, and
celloidin embedding. In 1917, Mandelbaum devised a
technique for the preparation of CB [9]. By its modifica-
tion in 1947, Chapman and Whalen [10] made the CB
history with serous effusion CB. After refrigeration over-
night, supernatant fluid was removed and residual cloud
or clotted material centrifuged. Zenkers’s fluid was added
to supernatant in a tube and fixed. Fixed block was dis-
lodged from the tube with a wire loop or forceps. The
block positioned on filter paper was sectioned. In time,
the better diagnostic accuracy with both smears and CBs
in comparison to only smears was shown by Richardson
et al. [11]. The remnant material after the smears were
done, was placed on porous filter paper, enclosed in a fine
wire meshed box, and after fixation in picric acid pro-
cessed into paraffin blocks [11].
2 Acta Cytologica
DOI: 10.1159/000489769
Fixation and Lysis
A wide range of histologic fixatives has been used for
CB including buffered formalin, neutral buffered formal-
dehyde solution, Bouin solution, picric acid fixative, Car-
noy fixative, and ethanol. Formalin gives the least satis-
factory results discriminating nuclear details from the cy-
tologists’ point of view [12]. Nathan introduced alcohol
formalin fixative [12]. Its advantage is antigenicity main-
tenance by alcohol and preservation of cell architec-
ture  and minimizing cell degradation by formalin [12,
13]. CytoRich Red Preservative containing isopropanol,
methanol, ethylene glycol, and formaldehyde lyses red
blood cells and solubilize protein, thus without having
any impact on the morphology of cells and increases the
cellular yield [14].
Simple Sedimentation
Simple sedimentation techniques face the problem of
insufficient cellularity and the sample is not suitable for
ancillary techniques in sparse samples, but it is applicable
in cell-rich effusions. The material is filtered through po-
rous filter paper in a funnel. After fixation, the material is
processed into a paraffin block together with wrapping
paper.
All the other techniques include an additional step of
centrifugation.
Pre-embedding adjuvants are indispensable in sam-
ples with low volume or low cell number [15]. The most
common adjuvants used are agar, thrombin, egg albu-
min, or sodium alginate [15, 16]. In exudates rich in fi-
brin, the pre-embedding adjuvants are not necessary for
producing an adhesive effect [16].
Normal Saline Rinse Needle Method
The fine needle aspirate needle can be rinsed by either
saline or fixatives such as formalin, paraformaldehyde, or
alcohol. The adverse effect of this is dilution of the mate-
rial [17].
Vapour-Fixed Fine Needle Aspiration Method
This technique does not require any special material
or equipment, so the author also named it the poor
man’s CB. The material is expelled from the needle
163.15.154.53 - 6/18/2018 6:28:55 PM
Kaohsiung Medical University Library
Krogerus/Kholová
Downloaded by:
to form a blob and vapor-fixed in a tube. After solidifi-
cation, it is flooded by formalin and picked up, dried
out,  and processed. The cells in this block are
­densely packed and suitable for immunohistochemistry
[18, 19].
Processing without Tissue Processor
There are CB techniques that do not require tissue
processors. In one of these, the alcohol-fixed cellular
material is pelleted, and then dehydrated with aceton,
pelleted again, dried in well-ventilated spaces, and then
immersed in warm molted paraffin, all in the same
tube. The CB, when cooled, can be tapped out and cut
[20, 21].
The Agarose Method
Agar is cheap and can be used in many ways to form a
solid lump with embedded cells that can then be pro-
cessed as a histological specimen.
Agar is purchased as a white powder, which is dis-
solved in boiling water (2.0 g agar with 50.0 mL of
aqua). This mixture is solidified in temperatures below
50 ° C. Be aware, however, that protein epitopes that we
are interested in may be lost in temperatures above
60 ° C due to protein denaturation. Agar is difficult to
    
dissolve in ethanol or xylene with a higher density or
lower permeability after solidification [15]. The cells
can be injected into the cooling agar with a needle or
they can be blended in the agar in a test tube. Then the
warm agar may be centrifuged, even with a marker in
the agar to get the cells down to the bottom in a tube
with a flat bottom [22]. The single cells are dispersed in
the agar in the tube, and if they are scanty, they can be
difficult to find, but if the cells are abundant, the space
around them may help in reading immunohistochemi-
cal slides. If you use the needle to inject cells into agar,
the material can have color in it to show the level of the
material in the block, to show, where to cut the block.
Often the sample is blood-mixed, which is enough to
color the sample and serve as marker for the material.
The cooled, solidified agar lump is easily falling out of
the tube when turned upside down, if not formalin or
saline can be injected under it with a small needle. The
lump then floats to the top of the tube [22, 23]. Heat
artifacts from molten agarose heating processing affect
morphology [24].
CBs Preparatory Techniques
The Sodium Alginate Method
The material is fixed in 10% formalin and centrifuged.
One percent sodium alginate is added to the sediment,
agitated, and centrifuged; after that a calcium chloride so-
lution is added, concretion is removed, and specimen is
embedded into paraffin. This method is simple [25].
The Pregelatinized Starch Method
The main advantage is handling the pregelatinized
starch at the room temperature. It effectively collects even
a few cells with powerful adhesiveness. Pregelatinized
starch and precipitate are mixed with a glass rod in 1:1
volume ratio. Achromatic starch crystals are observed
only in the minority of cases and they are mainly in the
periphery [15].
The Egg Albumen Method
Repeated precipitation and corrosion protection is
needed, so the technique is laborious and complicated
[15]. This adjuvant was used also in ultra-sound-pro-
cessed rapid CB method [16].
Blocks Using Glucomannan from Amorphophallus
konjac
Plant extracted glucomannan is used in the Asian cui-
sine. Chemically it is a water-soluble polysaccharide. The
glucomannan-formalin solution is added to centrifuged
suspended cells as well as to the cassette hole. The method
is feasible for special stains, immunohistochemistry, elec-
tron microscopy and molecular techniques [26].
Celloidin Socks
Originally described by Bussolati [27], the method is
an alternative to agar and plasma/thrombin CB meth-
ods. Colloidion is the unpurified form of celloidin, a
nitrocellulose material, the same material that is used in
Millipore filters. Celloidin containing liquid can be
bought (Colloidion Flexible USP, Mallincrodt #4580-
500-NY, Baxter scientific, McGrave Park III) and socks
or bags made of it, with the help of glass tubes. Into
these bags inside the tubes, cell suspensions can be cen-
163.15.154.53 - 6/18/2018 6:28:55 PM
Kaohsiung Medical University Library
Acta Cytologica 3
DOI: 10.1159/000489769
Downloaded by:
trifuged, and then the cells can be processed in the loos-
ened bags with histological material, without cellular
loss. The tubes with the bags can be prepared in ad-
vance and stored for months. This method is said to
give an excellent cell recovery rate and outstanding
preservation of the architecture of various neoplasms
[28, 29].
The Tissue Coagulum Clot Method
The technique was developed by Yasafuku and further
introduced into practice by Yung et al. [30]. The mixture
of cells and blood is coagulated in the lumen of the aspi-
ration needle and the tissue clot is transferred on filter
paper or a slide, air-dried, fixed, and further processed
[30]. Onsite evaluation of cellularity is not possible with
this technique [2].
Plasma-Thrombin/Thromboplastin Clot Method
The standard protocol for plasma-thrombin CB is to
add a minimal amount of plasma and thrombin to fresh
cellular sediments and then either wait for the clots to oc-
cur spontaneously or accelerate the clotting by putting
the tube with the material in hot water.
Powered fibrinogen and thrombin were first used to
form clots with cytological material by Birge et al. [31].
De Girolami [32, 33] showed the diagnostic use of the
method in the variety of the tissues and organs. Better cel-
lularity, morphology, cell distribution, and bigger pellet
size are appreciated by survey respondents [34].
The method has various modifications. Yang et al.
[35] introduced addition of CytoRich Red plasma-
thrombin clot, which is slit onto a lens paper placed on
paper towels. Lens paper keeps the cells while paper tow-
el absorbs the liquid making a diaper effect. In this so-
called compact, CB fibrin strands are not present after
manual packing. Karnauchow and Bonin used plasma
and thromboplastin to form a clot [36]. Thromboplastin
has longer shelf time than thrombin [37]. If the material
is fixed, thorough washing in isotonic saline is needed
before adding the plasma and thromboplastin [36, 37].
Smear material scraped with a scalpel blade with or with-
out destaining can be used for further CB processing [38,
39]. The self-clot method that uses the own blood of the
patient, contaminating the FNA sample was employed
by Shi [40]. FNA material was air-dried to form a blood
clot in a tube [40]. Skov and Skov [41] successfully tested
4 Acta Cytologica
DOI: 10.1159/000489769
plasma-thrombin CB method for programmed death-­
ligand 1 immunohistochemistry.
Rabbit brain or lung tissue as a source of commercial
thromboplastin can cause problems by contamination by
rabbit epithelial cells and may lead to erroneous interpre-
tation, so cell-free tromboplastin should always be used
[2, 42]. Samples from patients with anticoagulation ther-
apy are another challenge for clotting techniques.
Shandon® CB Method/Histogel Method
Histogel is an aqueous specimen-processing gel that
encapsulates and suspends both histologic and cyto-
logic specimens in a solidified medium. A centrifuged
cell pellet is enriched with commercial kit reagents and
centrifuged again. All reagents as well as CB casettes
are available in the kit [43]. A modified technique was
recently described by Rekhtman et al. [44]: the cell pel-
let is pretreated with 95% EtOH before the standard kit
steps. The volume and liquefaction times are standard-
ized according to the quantity of the material and an
extra centrifugation is added at the end. The satisfac-
tion in a multicenter survey of the Histogel-method
was the lowest due to low cellular yield; nevertheless,
cellular preservation and architecture are appreciated
[34].
The Cell-Gel Method and the Histogel Tube Method
Hemolytic fixative is added to concentrated fluid spec-
imens or FNA samples; these can be submitted directly
into hemolytic fixative. A further step is the use of a dis-
posable base mold allowing even distribution of cells in a
well-defined surface area. Alternatively, tubes can be
used; however, a limitation of this method is a difficulty
to remove the material from the molds or tubes, leading
to the fragmentation and concentration of the material in
the tip of the tube, compromising optimal embedding
and sectioning [14].
The Ultrasound-Processed Rapid CB Method
The CB material was processed by ultrasound-acceler-
ated processing that decreased total processing time to
3 h, as adjuvant egg albumin was used. The method was
validated diagnostically as well as for further immunohis-
tochemistry and molecular usage [16].
163.15.154.53 - 6/18/2018 6:28:55 PM
Kaohsiung Medical University Library
Krogerus/Kholová
Downloaded by:
 The Rapid CB Method
Another rapid CB method used circular polycar-
bonate filters positioned below tissue cassettes at
the  plane of microtome section capture. Trapped
cells and fragments on the filter were thrown through
100% isopropyl alcohol, xylene, and melted paraffin
[45].
Inverted Filter Sedimentation
This method is the predecessor of The Cellient® Au-
tomated CB System. Remnant material from liquid based
cytology samples were allowed to sediment in the invert-
ed filter cylinder. Filter with sediment was than pro-
cessed half folded in lens- or biopsy tissue paper into CB
[46].
The Cellient® System
The Cellient® Automated CB System creates CBs by
using vacuum filtration to deposit a layer of cells and tis-
sue fragments on a membrane filter and infiltrates those
cells with reagents and paraffin. The cells are concen-
trated at a defined part on top of the block helping mi-
crotomy cutting and thus increasing the number of cells
on the slides. As a bonus, the rapid processing only lasts
an hour. The system is feasible for low concentration
samples [47, 48]. The morphological features were shown
to be improved in comparison with the agar CB method
[49]. The feasibility for various tissues was shown [48–
50] as well as applicability for immunohistochemistry
and molecular analyses [48, 51, 52] with some false pos-
itive results for progesterone and estrogen receptors
[52]. The system is costly, but cost-effectiveness is
reached by saving preparation time and shortened sam-
ple turn time. In addition, enhanced cellular yield is ap-
preciated [34].
Millipore Filter CB Preparation
The method is applicable only for Millipore mem-
branes; that are rolled into a tube shape, with the filtered
cells on them, cut in half, and placed in paraffin cassettes.
The cells are concentrated on the edge of the section, 20–
30 in number, morphologically ­preserved, and suitable
for immunohistochemistry [53].
CBs Preparatory Techniques
A Formalin-Fixed, Paraffin-Embedded CB Technique
Method
A formalin-fixed, paraffin-embedded CB technique
(AFFECT) employs a funnel to deposit a cell pellet into a
well on a piece of open-cell, absorbent foam during cyto-
centrifugation. The foam and the pellet are routinely pro-
cessed together [24].
Collection of Visible Tissue Fragments
If a specimen contains small fragments, these are of
course best treated as miniature histological biopsies in a
histolab [54, 55]. Many laboratories just pick up the visi-
ble fragments; however, cells with low cohesion are lost.
Marking the CB
Various dyes and sutures were introduced to make
cells visible for cutting. Karnauchow has employed tolu-
idine blue [36]. Yang et al. [35] used mercurochrome.
Dark-colored synthetic surgical sutures of 3–5 mm length
were successfully tested by Rekhtman et al. [44]. Blood
clots as natural markers were suggested too [40]. Of note
is that the block markers in paraffinized agarose are often
moved out of the plane due to the buckling [24].
Conclusions
In general, CBs sensitivity alone is lower in compari-
son to cytology; however, CB improves the diagnostics
when applied together with smears. In contrast to the ma-
jority of surgical specimens, cytological material enables
immediate onsite assessment (rapid on site evaluation),
which may improve the diagnostic yield and specimen
adequacy. Rapid on site evaluation can also be done with
touch imprint of core biopsies [56]. Cytological material
contains less stromal and other cellular contaminations,
compared to histological sections. It is of importance that
the increased number of FNA passes improved the cellu-
larity of CBs [57]. In addition, accurate needle lavage in
FNA cases is important. Cytological material is not al-
ways available for CB preparation and the cellularity of
the CB can be less than optimal. In summary, preanalytic
variables including type, nature, and location of lesion,
and the skill and technique of operator obtaining the sam-
ple are of paramount importance.
163.15.154.53 - 6/18/2018 6:28:55 PM
Kaohsiung Medical University Library
Acta Cytologica 5
DOI: 10.1159/000489769
Downloaded by:
 Upon the receipt of a specimen, the material should be
inspected and the method most applicable to the particu-
lar specimen should be utilized. The documentation of
material characteristics should be implemented in the
laboratory system. The idea of triage was postulated al-
ready in the 50s by Birge et al. [31]; nevertheless, the ma-
jority of laboratories employ only limited CB techniques.
In the survey of Crapanzano et al. [34], over 10 methods
were used in the respondents’ institutions most common-
ly the plasma/thrombin method, the Histogel- and Cel-
lient CB-techniques. The limited satisfaction with CBs
due to low cellularity was clearly shown.
It is always rewarding to have many kinds of prepara-
tions when making cytological diagnoses. This helps in
analyzing all the properties of cells. But as always with
needle diagnostics, the paucity of material is the greatest
limiting factor. Even if we know that it is possible to get
millions of cells in a small needle. CBs give more archi-
tectural detail of groups than conventional cytology. Hav-
ing immunostains is mandatory today to correctly iden-
tify and name tumors. In CBs, material from lesions is
preserved for future use, which is an additional advantage
in the era of targeted therapy. Alcohol-fixation is a better
preservative for DNA than formalin.
The majority of the studies on CBs are made on lim-
ited types of material (either effusions or FNAs) not rep-
resenting the whole spectrum of cytology, and further-
more numbers of studied cases are limited (in 10s). Fur-
ther, wide range studies implementing the triage of the
material are awaited.
There is a tendency to use less invasive procedures at
outpatient clinics for diagnostics, and for this purpose,
cytological techniques suit better than classical surgical
methods. The CB is thus central to the future of cytology:
we can do more with less [24].
Disclosure Statement
The authors have no conflicts of interest.

References
  1 Koss LG, Melamed MR: Breast; in Koss LG,
Melamed MR (eds): Koss’s Diagnostic Cytol-
ogy and Its Histopathologic Basis. Philadel-
phia, Lippincott Williams and Wilkins, 2006,
pp 1590–1591.
  2 Jain D, Mathur SR, Iyer VK: Cell blocks in cy-
topathology: a review of preparative methods,
utility in diagnosis and role in ancillary stud-
ies. Cytopathology 2014;25:356–371.
  3 Kalhor N, Wistuba II: Perfecting the fine-nee-
dle aspirate cell block. Cancer Cytopathol
2013;121:109–110.
  4 Herbert A: Cell blocks are not a substitute for
cytology: why pathologists should under-
stand cytopathology particularly in their cho-
sen speciality. Cytopathology 2014; 25: 351–
355.
  5 Roy-Chowdhuri S, Stewart J: Preanalytic vari-
ables in cytology. Arch Pathol Lab Med 2016;
140:1191–1199.
  6 Schmitt FC, Vielh P: Expectations and pro-
jections for the future of nongynecolgical
cytology 10 years ago: did they materialize
and how did we do. Acta Cytol 2017;61:373–
407.
 7 Martins D, Beca F, Schmitt F: Metastatic
breast cancer: mechanisms and opportunities
for cytology. Cytopathology 2014; 25: 225–
230.
  8 Bahrenburg LPH: On the diagnostic results of
the microscopical examination of the ascitic
fluid in two cases of carcinoma involving the
peritoneum. Cleveland Med Gaz 1896; 11:
274–278.
  9 Mandelbaum FS: The diagnosis of malignant
tumors by paraffin sections of centrifuged ex-
udates. J Lab Clin Med 1917;2:580.
10 Chapman CB, Whalen EJ: The examination
of serous fluids by the cell-block technic. N
Engl J Med 1947;237:215–220.
11 Richardson HL, Koss LG, Simon TR: An
evaluation of the concomitant use of cyto-
logical and histocytological techniques in the
recognition of cancer in exfoliated material
from various sources. Cancer 1955; 8: 948–
950.
12 Nathan NA, Narayan E, Smith MM, Horn MJ:
Cell block cytology. Improved preparation
and its efficacy in diagnostic cytology. Am J
Clin Pathol 2000;114:599–606.
13 Desai KM, Angadi PV, Kale AD, Hallikeri-
math S: Modified alcohol-formalin cell block
technique in head and neck pathology diag-
nosis. Acta Cytol 2018;62:39–43.
14 La Fortune KA, Randolph ML, Wu HH, Cra-
mer HM: Improvements in cell block process-
ing: the cell-gel method. Cancer Cytopathol
2017;125:267–276.
15 He QL, Zhu YZ, Zheng GJ, Shi LC Hu SW,
Li CT: A new convenient technique for mak-
ing cell blocks. Cell Tissue Res 2012;350:395–
400.
16 Zhao J, Lin DL, Zhai LH, Wang JG: Evalua-
tion of ultrasound-processed rapid cell blocks
in the cytopathologic diagnosis of cavity flu-
ids. Acta Cytol 2014;58:182–191.
17 Zito FA, Gadaleta CD, Salvatore C, Filotico R,
Labriola A, Marzullo A, Prete F, Marzullo F:
A modified cell block technique for fine nee-
dle aspiration cytology. Acta Cytol 1995; 39:
93–99.
18 Mayall F, Darlington A, Harrison B: Fine nee-
dle aspiration cytology in the diagnosis of un-
common types of lymphoma. J Clin Pathol
2003;56:728–730.
19 Mayall F, Darlington A: The poor man’s cell
block. J Clin Pathol 2010;63:837–838.
20 Krogerus LA, Andersson LC: A simple meth-
od for the preparation of paraffin-embedded
cell blocks from fine needle aspirates, effu-
sions and brushings. Acta Cytol 1988;32:585–
587.
21 Domagala WM, Markiewski M, Tuziak T,
Kram A, Weber K, Osborn M: Immunocyto-
chemistry on fine needle aspirates in paraffin
miniblocks. Acta Cytol 1990;34:291–296.
22 Varsegi GM, Shidham V: Cell block prepara-
tion from cytology specimen with predomi-
nance of individually scattered cells. J Vis Exp
2009;29:e1316.
23 Mansy SS, Abbas MA, Yehia HA, Abdelrazik
SM, Ghanem LY, Amin TM: Value of the in-
novated technique agarose cell block in im-
proving the sensitivity of urine cytology in
cases of bladder carcinoma. Ultrastruct
Pathol 2006;30:379–385.
24 Lindsey KG, Houser PM, Shotsberger-Gray
W, Chajewski OS, Yang J: Young investigator
challenge: a novel, simple method for cell
block preparation, implementation, and use
over 2 years. Cancer Cytopathol 2016; 124:
885–892.
163.15.154.53 - 6/18/2018 6:28:55 PM
Kaohsiung Medical University Library

6 Acta Cytologica Krogerus/Kholová

DOI: 10.1159/000489769
Downloaded by:
25 Noda Y, Fujita N, Kobayashi G, Itoh K, Hor-
aguchi J, Takasawa O, Obana T, Koshita S,
Kanno Y, Suzuki T, Hirasawa D, Sugawara
T, Ohira T, Harada Y, Tsuchiya T, Sawai T,
Uzuki M, Kurose A: Diagnostic efficacy of
the cell block method in comparison with
smear cytology of tissue samples obtained
by endoscopic ultrasound-guided fine-nee-
dle aspiration. J Gastroenterol 2010; 45: 868–
875.
26 Kaneko C, Kobayashi TK, Hasegawa K,
Udagawa Y, Iwai M: A cell-block preparation
using glucomannan extracted from Amor-
phophallus konjac. Diagn Cytopathol 2010;
38:652–656.
27 Bussolati G: A celloidin bag for the histologi-
cal preparation of cytologic material. J Clin
Pathol 1982;35:574–576.
28 Fahey C, Bedrosian UK: Collodion bag: a cell
block technique for enhanced cell collection.
Lab Med 1993;74:94–96.
29 Balassanian R, Wool GD, Ono JC, Olejnik-
Nave J, Mah MM, Sweeney BJ, Liberman H,
Ljung BM, Pitman MB: A superior method
for cell block preparation for fine-needle aspi-
ration biopsies. Cancer Cytopathol 2016;124:
508–518.
30 Yung RC, Otell S, Illei P, Clark DP, Feller-
Kopman D, Yarmus L, Askin F, Gabrielson E,
Li QK: Improvement of cellularity on cell
block preparations using the so-called tissue
coagulum clot method during endobronchial
ultrasound-guided transbronchial fine-nee-
dle aspiration. Cancer Cytopathol 2012; 120:
185–195.
31 Birge RF, McMullen T, Davis SK: A rapid
method for paraffin section study of exfoliat-
ed neoplastic cells in bodily fluids. Am J Clin
Pathol 1948;18:754.
32 De Girolami E: Applications of plasma-
thrombin cell block in diagnostic cytology.
Part 1: female genital and urinary tracts.
Pathol Annu 1977;12:251–275.
33 De Girolami E: Application of plasma-throm-
bin cell block in diagnostic cytology. Part 2:
digestive and respiratory tracts, breasts and
effusions. Pathol Annu 1977;12:91–110.
34 Crapanzano JP, Heymann JJ, Monaco S, Nas-
sar A, Saqi A: The state of cell block variation
and satisfaction in the era of molecular diag-
nostics and personalized medicine. Cytojour-
nal 2014;11:7.
35 Yang GC, Wan LS, Papellas J, Waisman J:
Compact cell blocks. Use for body fluids, fine
CBs Preparatory Techniques
needle aspirations and endometrial brush bi-
opsies. Acta Cytol 1998;42:703–706.
36 Karnauchow PN, Bonin RE: “Cell-block”
technique for fine needle aspiration biopsy. J
Clin Pathol 1982;35:688.
37 Kulkarni MB, Desai SB, Ajit D, Chinoy RF:
Utility of the thromboplastin-plasma cell-
block technique for fine-needle aspiration
and serous effusions. Diagn Cytopathol 2009;
37:86–90.
38 Bhatia P, Dey P, Uppal R, Shifa R, Srinivasan
R, Nijhawan R: Cell blocks from scraping of
cytology smear: comparison with conven-
tional cell block. Acta Cytol 2008;52:329–333.
39 Kulkarni MB, Prabhudesai NM, Desai SB,
Borges AM: Scrape cell-block technique for
fine needle aspiration cytology smears. Cyto-
pathology 2000;11:179–184.
40 Shi Y, Chiaffarano J, Yee-Chang M, Brandler
TC, Elgert P, Leung A, Wei XJ, Cangiarella J,
Simsir A, Sun W: Self-clotting method im-
proves cell block preparation. Cancer Cytopa-
thol 2018;126:190–199.
41 Skov BG, Skov T: Paired comparison of PD-
L1 expression on cytologic and histologic
specimens from malignancies in the lung as-
sessed with PD-L1 IHC 28-8pharmDx and
PD-L1 IHC 22C3pharmDx. Appl Immuno-
histochem Mol Morphol 2017;25:453–459.
42 Henwood AF, Charlton A: Extraneous epi-
thelial cells from thromboplastin in cell
blocks. Cytopathology 2014;25:412–421.
43 Khan S, Omar T, Michelow P: Effectiveness of
the cell block technique in diagnostic cytopa-
thology. J Cytol 2012;29:177–182.
44 Rekhtman N, Buonocore DJ, Rudomina D,
Friedlander M, Dsouza C, Aggarwal G, Arcila
M, Edelweiss M, Lin O: Novel modification of
histoGel-based cell block preparation meth-
od: improved sufficiency for molecular stud-
ies. Arch Pathol Lab Med 2018;142:529–535.
45 Fischer AH, Vartanian H, Hanc BJ, Scott MP,
Eaton DM, Fischer NC, Woda BA: Efficient
technique for making paraffin-embedded
“rapid cell blocks” in 12 minutes. Mod Pathol
2006;19:57.
46 Diaz-Rosario LA, Kabawat SE: Cell block
preparation by inverted filter sedimentation
is useful in the differential diagnosis of atypi-
cal glandular cells of undetermined signifi-
cance in ThinPrep specimens. Cancer Cyto-
pathol 2000;90:265–272.
47 Hecht SA, McCormack M: Comparison of
three cell block techniques for detection of
Acta Cytologica
DOI: 10.1159/000489769
low frequency abnormal cells. Pathol Lab
Med Int 2013;5:1–7.
48 Prendeville S, Brosnan T, Browne TJ,
­McCarthy J: Automated Cellient(TM) cytob-
locks: better, stronger, faster? Cytopathology
2014;25:372–380.
49 Kruger AM, Stevens MW, Kerley KJ, Carter
CD: Comparison of the Cellient(TM) automat-
ed cell block system and agar cell block meth-
od. Cytopathology 2014;25:381–388.
50 Xing W, Hou AY, Fischer A, Owens CL, Jiang
Z: The Cellient automated cell block system is
useful in the differential diagnosis of atypical
glandular cells in Papanicolaou tests. Cancer
Cytopathol 2014;122:8–14.
51 van Hemel BM, Suurmeijer AJ: Effective ap-
plication of the methanol-based preservCyt(TM)
fixative and the Cellient automated cell block
processor to diagnostic cytopathology, immu-
nocytochemistry, and molecular biology. Di-
agn Cytopathol 2013;41:734–741.
52 Gorman BK, Kosarac O, Chakraborty S,
Schwartz MR, Mody DR: Comparison of
breast carcinoma prognostic/predictive bio-
markers on cell blocks obtained by various
methods: Cellient, formalin and thrombin.
Acta Cytologica 2012;56:289–296.
53 Baloch ZW, Lee A, Cobbs C, Roberts S,
LiVolsi VA, Gupta PK: Millipore filter cell
block preparation: an alternative to cell
block in nongynecologic specimens of lim-
ited cellularity. Diagn Cytopathol 1999; 20:
389–392.
54 Smedts F, Schrik M, Horn T, Hopman AH:
Diagnostic value of processing cytologic aspi-
rates of renal tumors in agar cell (tissue)
blocks. Acta Cytol 2010;54:587–594.
55 Kerstens HM, Robben JC, Poddighe PJ,
Melchers WJ, Boonstra H, de Wilde PC,
Macville MV, Hanselaar AG: AgarCyto: a
novel cell-processing method for multiple
molecular diagnostic analyses of the uterine
cervix. J Histochem Cytochem 2000; 48: 709–
718.
56 Kubik MJ, Bovbel A, Goli H, Saremian J, Sid-
diqi A, Masood S: Diagnostic value and accu-
racy of imprint cytology evaluation during
image-guided core needle biopsies: review of
our experience at a large academic center. Di-
agn Cytopathol 2015;43:773–779.
57 Collins BT, Garcia TC, Hudson JB: Effective
clinical practices for improved FNA biopsy
cell block outcomes. Cancer Cytopathol 2015;
123:540–547.
163.15.154.53 - 6/18/2018 6:28:55 PM
Kaohsiung Medical University Library
7
Downloaded by: