Journal of Cancer Therapy, 2010, 1, 192-194
doi:10.4236/jct.2010.14029 Published Online December 2010 (http://www.scirp.org/journal/jct)
Liquid Based Cytology of Cell Remnants in
Needles Used for Breast Fine Needle Aspiration
Godwin Avwioro1, Sina Iyiola2, Julius Bankole3, Da n i e l Os i a g w u 4, Ahmad Muhammad5
1Faculty of Basic Medical Sciences, Delta State University, Abraka, Nigeria;2Department of Histopathology, Obafemi Awolowo
University Teaching Hospital, Ile-Ife, Nigeria;3Department of Medical Labor atory Science, Ambrose Alli University, Ekpoma Nig eria
4Department of Histopathology, Lagos University Teaching Hospital, Lagos, Nigeria;5Department of Histopathology, School of
Medical Laboratory Science, Usmanu Danfodiyo University, Sokoto, Nigeria.
Received: July 30th, 2010; revised August 6th, 2010; accepted September 14th, 2010.
ABSTRACT
This study examined cells contain ed in needles used fo r the collection of breast fine needle asp irates for the d etection of
malignant cells trapped in the needles. Remnants of cells contained in 50 needles used for the collection of scanty
breast fine needle aspirates were examined by the liquid based cytology technique and compared with the conventional
cytological technique of specimens in the corresponding syringes. The breast specimens were collected with clean ster-
ile needles attached to the syringes. Smears were made and stained by the conventional method. The needles were re-
moved from the syringes and a fixative was withdrawn into the syringes and the syringes were recapped with the nee-
dles. The fixative containing the specimen was then completely discharged into a centrifuge tube through the needles
and treated by the liquid based cytology technique. The study revealed that cells were found trapped in all the needles
used for the collection of breast FNA. 6% of them were positive for malignancy, similar to results obtained in the con -
ventional method. Needles used for the collection of breast FNA should be examined before malignancy is completely
ruled out particularly in extremely scanty specimens with a clinica l suspicion of malignancy.
Keywords: Liquid Based Cytology, Needle Cell Remnants, Fine Needle Aspiration, Breast
1. Introduction
Liquid-based cytology is a technique that enables cells to be
suspended in a monolayer and thus making better mor-
phological assessment possible with improved sensitivity
and specificity because fixation is better and nuclear details
are well preserved in this technique. Abnormal cells are not
obscured by other epithelial or inflammatory cells [1]. The
method involves collection of specimens directly into a
liquid fixative, but in the case cervical specimens, with a
brush-like device, Cervex-brush (Rovers medical devices),
The brush is used to scrape the cervix according to the
manufacturer's instructions, viz. insertion of long bristles
into endocervical canal, short bristl es against the ectocervix
and five full 360º rotations in cl ockwise direction only. The
brush head is then detached and im mediately put int o a vial
containing a special commercial fixative solution such as
SurePath preservative fluid [1]. Smears are made from the
sediment, stained and evaluated. Two techniques - Thin
Prep (Cytyc Corp.) and SurePap (Tripath imaging, Inc.)
have been more widely used [1]. The int roduction of l iquid
based cytology has led to improvements in unsatisfactory
smear rates, with significant benefits to colposcopic refer-
rals and laboratory turnaround times and colposcopic re-
ferrals for repeated unsatisfactory smears has fallen from
almost 25% to 0.5%, while the percent age of unsatisfactory
smears has fallen from 13.6% to 1.9% [2]. The superiority
of the quality of liquid based cytology in comparison with
those of conventional smears has been described [3,4]. The
sensitivity of a conventional Pap smear is estimated to be
70-80% and about 85-95% for liquid-based cytology tests
[5]. Liquid-based cytology is now recommended for cer-
vical cancer screening [6] with a major advantage of al-
lowing ancillary techniques such as those used in immu-
nocytochemistry and m olecular biology [7,8]. Liquid-based
cytology was introduced as an improvement of the Pap
smear technique for cervical specime ns but it has also been
used for non-gynaecologic cytology [9] and brilliant results
have been obtained. The aim of this work was to determine
by liquid based cytology the diagnostic value of remnants
of cells in needles which are meant to be discarded after the
conventional cytological technique for breast specime ns.

Liquid Based Cytology of Cell Remnants in Needles Used for Breast Fine Needle Aspiration 193
2. Materials and Methods
Fifty breast aspirates received in needles and syringes
were studied. The needles were removed from the sy-
ringes after the smears were made by the conventional
method. 10ml of liquid based fixative was then aspirated
into the syringe and the needle was attached to the syringe.
The fixative was then expelled through the needle forcing
the cells to be released with the fixative. This was col-
lected in a centrifuge tube and allowed to fix for 2 hours
and was ce ntrif uged fo r about 10 min utes at 100 0 rpm a nd
the supernatant removed. 5 ml of a cleaning solution was
added to the sediment and spun for 10 minutes. The su-
pernatant was removed and a cellular base added and
mixed with vortex for 1 minute. Smears were made from
the sediment and stained with haematoxylin and eosin
(H&E) by applying Harris haematoxylin for 4 minutes.
The smear was then rinsed in water, differentiated in 1%
acid-alcohol for 3 seconds, rinsed in water, blued in
Scott’s solution for 2 minutes and counterstained in 1%
eosin for 30 seconds. Smears were then dehydrated
through ascending grades of alcohol, cleared in xylene
and coverslipped on DPX. The smears made by the con-
ventional method were also stained with H&E and ex-
amined under the X40 microscope objective.
3. Results
The smears from four patients had a clean background
with a uniform cell distribution with very few cases of
overlapping of cells. The struct ure of the cells and nuclear
appearance were well preserved with a good resolution
which enabled a clearer and ac curate identification of cells
under the microscope. Cells in sheets were also retained
without disrupting their diag n ost i c val ue.
4. Discussion
Breast carcinomas are the most frequent tumors in women.
Table 1. Appearance and percentage of positive smears in
remnants of cells in needles compared with the conventional
method.
Appearance of smear Posi- tive
smears
Nega-
tive
smears
% of
positive
smears
LBC of
remnants
of cells
in nee-
dles
Clean background with
good morphological
assessment. Good fixa-
tion and well preserved
nuclear details.
3 47 6
Conven-
tional
method
Similar to liquid based
cytology of remnants of
cells in needles except
with pinkish backg round
with some overlapping
cells
3 47 6
Figure 1. Smears of cell remnants made from four needles
treated by liquid based technique (H&E X40).
In several countries, mammogr aphic screen ing allows the
early diagnosis of tumors. However, when a tumor is
suspected, morphological analysis alone can establish the
diagnosi s of carci noma. I n this context, guided fine needle
aspiration has become increasingly popular for obtaining
tissue specimens for the diagnosis of malignant breast
diseases [10]. Liquid-based cytology in breast FNA had a
good correlation with conventional preparation of breast
FNA with the advantages of easier and less time con-
suming evaluation of cell morphology (clear background,
no overlapping, smaller area to screen), reproducibility, a
factor of great importance to quality control; and possi-
bility of adjunctive investigations such as immunocytol-
ogy and flow cytometry on the same material [11]. This
has been corroborated with the addition that quantitative
analysis of HER-2 mRNA correlated with the results of
immunohistochemistry in cancer patients [12]. We have
found similar morphological characteristics in our study
with the ability to produce multiple clean smears from a
single needle containing cells from breast specimen. This
study has revealed that cells of diagnostic value are often
trapped in the needles used for the collection of breast
aspirates and should be examined before malignancy is
completely ruled out, particularly in extremely scanty
breast specimens where clinical diagnosis suggests ma-
lignancy. A major disadvantage of extracting cells from
used needles is the risk of accidental puncture of the fin-
gers with such used needles which may contain virulent
bacteria and viruses. For this reason, extreme care should
be taken when handling used needles [13].
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