FNAC, cell block and core needle biopsy in diagnosis of lung masses: a necessity or choice?

Manjiri M. Makde, Pradeep Umap, Radha Munje


Background: Lung cancer is the commonest cancer mortality in the world. In targeted therapy era, precise cytohistological diagnosis is offered traditionally by FNAC, Cell Block (CB) and Core Needle Biopsy (CNB). However, little is known whether one technique is superior to other or all the three techniques complement each another. Therefore, this is a unique study as no other study has compared these techniques together till date. The objective of the study was to evaluate performance of FNAC, Cell block (CB) and Core Needle Biopsy (CNB) individually and comparing them with each other.

Methods: This was a prospective study of 50 cases who underwent two passes-1st for FNAC smears and Cell Block and 2nd for CNB.

Results: Material was Inadequate in 8 cases by FNAC 16 with Cell Block and 02 with CNB. When adequate, diagnosis and typing was possible by Cell Block (32) and CNB (48). In 08 FNAC cases having adequate material, cytological typing wasn’t possible. These 08 cases were typed by cell block as 07 malignant and 01 pre-malignant. The combined inadequate cases with cyto-technique (FNAC and Cell Block) were 04 compared to 02 cases on CNB. Combined sensitivity of Cyto-techniques was 95.4% compared to 97% on CNB. The specificity was 100% for both Cyto-techniques and CNB.

Conclusions: Diagnostic adequacy and test parameters improved and approached CNB when both cyto-techniques are combined. So, we strongly recommend that Cell Block be made routine diagnostic procedure in all the government institutions especially for guided FNAC.


Cell block, Core needle biopsy, FNAC, Lung masses

Full Text:



Ferlay J, Shin HR, Bray F. Estimates of worldwide burden of cancer in 2008: globocan 2008. Int J Cancer. 2010;127:2893-917.

Steven Leong, Tawimas Shaipanich, Stephen Lam, Kazuhiro Yasufuku. Diagnostic bronchoscopy--current and future perspectives. J Thorac Dis. 2013; 5:498-510.

Morgan R. Davidson, Adi F. Gazdar, Belinda E. Clarke. The pivotal role of pathology in the management of lung cancer. J Thorac Dis. 2013;5: 463-78.

Ensani F, Nematizadeh F, Irvanlou G. Accuracy of immunohistochemistry in evaluation of malignant pleural and peritoneal effusions. Pol J Pathol. 2011; 62:95-100.

Mondal SK, Nag D, Das R, Mandal PK, Biswas PK, Osta M. Computed tomogram guided fine-needle aspiration cytology of lung mass with histological correlation: A study in Eastern India. South asian journal of cancer. 2013;2(1):14.

Khan S, Omar T, Michelow P. Effectiveness of the cell block technique in diagnostic cytopathology. J Cytol. 2012;29(3):177-82.

Koksal D, Demirag F, Bayiz H. The cell block method increases the diagnostic yield in exudative pleural effusions accompanying lung cancer. Turk Patoloji Derg. 2013;29:165-70.

Billah S, Stewart J, Staerkel G. EGFR and KRAS mutations in lung carcinoma: molecular testing by using cytology specimens. Cancer Cytopathol. 2011;119:111-7.

Wallace MJ, Krishnamurthy S, Broemeling LD, Gupta S, Ahrar K, Morello FA et al. CT guided percutaneous fine needle aspiration biopsy of small (≤1­cm) pulmonary lesions. Radiol, 2002;225: 823­8.

Tan KB, Thamboo TP, Wang SC, Nilsson B, Rajwanshi A, Salto­Tellez M. Audit of transthoracic fine needle aspiration of the lung: Cytological sub classification of bronchogenic carcinomas and diagnosis of tuberculosis. Singapore Med J. 2002; 43:570-5.

Bandyopadhyay A, Laha R, Das TK, Sen S, Mangal S, Mitra PK. CT guided Fine needle aspiration cytology of thoracic mass lesions: A prospective study of immediate cytological evaluation. Indian J Pathol Microbiol. 2007;50:51-5.

Saha A, Kumar K, Choudhuri MK. Computed tomography­guided fine needle aspiration cytology of thoracic mass lesions: A study of 57 cases. J Cytol. 2009;26:55-9.

Muhammad Furrukh. Tobacco Smoking and Lung Cancer Perception-changing facts. Sultan Qaboos Univ Med J. 2013;13(3):345-58.

Madan M, Bannur Evaluation of FNAC in lung diseases. Turk J Pathol. 2010;26:1-6.

Akalin A, Lu D, Woda B, Moss L, Fischer A. Rapid cell blocks improve accuracy of breast FNAs beyond that provided by conventional cell blocks regardless of immediate adequacy evaluation. Diagn Cytopathol. 2008;36:523-9.

Zito FA, Gadaleta CD, Salvatore C. A modified cell block technique for fine needle aspiration cytol. Acta Cytol. 1995;39:93-9.

Mayall F, Chang B, Darlington A. A review of 50 consecutive cytology cell block preparations in a large general hospital. J Clin Pathol. 1997;50:985-90.

Kim MJ, Kim EK, Park SI, Kim BM, Kwak JY, Kim SJ, et al. US­guided fine­needle aspiration of thyroid nodules: indications, techniques, results. Radiographics. 2008;28:1869-89.

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.

Ali SA. Sensitivity and specificity of combined fine needle aspiration cytology and cell block biopsy versus needle core biopsy in the diagnosis of sonographically detected abdominal masses. World Family Medicine J: Incorporating the Middle East J Family Medic. 2015;13(6):13-9.

Hegazy RA, Hegazy AA, Fetouh FA, Ibrahim S. Fine needle aspiration cytology and cell-block study of various breast lumps. American J Biomedic and Life Sciences. 2014;2(1):8-17.