Serous Effusion Survey 2009

In 2009 a survey on serous effusion preparation was sent to all participants enrolled in the Cytopathology QAP non- gynae modules. 162 of 184 (84%) laboratories responded to this survey.

Of 162 laboratories who responded, 154 (95%) said that their laboratory reported serous effusion specimens.

Of 84 Australian laboratories who responded, 77 (91%) report effusion specimens in their laboratory.

The total number of effusion specimens reported per laboratory in the 3 month period from Feb 1 to May 2009 ranged from 0-402.

Most laboratories (138/151, 91%) preferred to receive effusion specimens fresh and did not recommend the use of a particular media for collection. Only 13 laboratories reported the use of sodium citrate, ethanol or cytolyte for collection of specimens.

Serous effusions were most often prepared using cell smears and/or cytospins (148/168 laboratories, 88%), with only 3 laboratories using filter preparations and 17 laboratories preferring liquid based preparation techniques.

Two to four slides were prepared by 122 laboratories (total 122/139 laboratories, 87.8%), with the remaining preparing 5-12 slides per case.

The majority of laboratories (127/156, 81%) used both Papanicolaou and Giemsa as routine staining methods with 18 laboratories utilising H&E also.

92/154 (59%) of laboratories employed methods to reduce blood contamination in effusion specimens with 27 using Carnoy’s solution. Other methods included Cytolyte, acetic acid, HMS and Ficoll.

94 of 113 (83%) of laboratories who reported having a protocol to deal with clots utilised cell blocks for this purpose while 40 (26%) responded that they did not have any such method. Cell block preparations were routinely used by 78 (50.6%) laboratories, only when required by 65 (42.2%) laboratories and never by 11 (7.1%) laboratories. The cell block method of choice included agar (46), thrombin clot (74), centrifugation (19), clotted specimen (26), albumin (3). Other methods used include FAA, Cellient, cell block fixative.

Laboratories reported that special stains were usually performed only when required (134 laboratories, 87.6%), routinely (8 laboratories) and never by 11 laboratories. When special stains were performed, cell smears were rarely used (93, 81.6%) while 108 (78.8%) laboratories used cell blocks for this purpose.

When differentiating reactive mesothelial cells from adenocarcinoma and mesothelioma special stains most likely to be preformed are Calretinin (97), CEA (73), PAS/D (62), CK5/6 (53), EMA (44) and TTF1 (30).

Histochemical stains were performed in house at 140/149 (93%) laboratories and immunohistochemical stains were performed in house at 130/151 (86.1%) laboratories.

Ultrastructural studies were rarely used to assist in the differential diagnosis of reactive mesothelial cells and adenocarcinoma and mesothelioma (17/150 laboratories, 11.3%). Flow cytometry (cell surface marker analysis) was performed by 76/153 (49.7%) laboratories. Flow cytometric analysis was utilised when there was clinical history of leukemia/lymphoma, when there was a cytological suspicion of lymphoma, in the presence of lymphocytosis or at the request of the clinician or pathologist.

In summary most laboratories report serous effusion specimens and recommend the specimens are collected fresh. Cell smears/cytospins are the most common preparation technique with 2 to 4 slides prepared per case. Both Papanicolaoou and Giemsa stains are used routinely together with some method to remove excessive blood when required. Clots are usually prepared using a cell block and cell blocks are routinely prepared in about half the laboratories who responded. The most common cell block method is thrombin clot. Special stains are usually done only when required and usually on slides prepared from cell blocks. Histochemical and immunochemical stains are usually done in-house. Ultrastructural studies are rarely done. Flow cytometric analysis is performed by approximately half the respondent laboratories, usually when there is a suspicion of lymphoma but also because of clinical history, the presence of lymphocytosis or at the request of the clinician or pathologist.

SurePath Pilot 2009

In 2009, commencing with Survey 2, all laboratories enrolled in the LBC module were sent one SurePath slide and invited to respond. The pilot was optional and not for assessment. Overall participation by all laboratories was 84% and is shown in Table 1:

Table 1
PARTICIPATION	SURVEY 2	SURVEY 3	SURVEY 4
Total Labs sent SurePath slides	102	103	103
No results returned	82(80%)	84(82%)	85(82%)

The SurePath slides included a variety of diagnoses from benign to HGSIL and the results were generally of a high standard. The number of minor and major errors is shown in Table 2: