Cytophotometry of breast carcinoma. Acridine-orange DNA microfluorimetry with Giemsa counterstain

Investigations have suggested that a correlation exists between DNA ploidy levels and prognosis in human breast carcinoma. Nuclear DNA content can be studied by flow cytometry or cytophotometric analysis. While both methods yield comparable results for DNA distribution, cytophotometry has the advantage of permitting both quantitative cell measurements and cytomorphologic identification of tumor cells. Microfluorimetric analysis of nuclear DNA content was carried out on acridine-orange-stained imprint smears of malignant breast tumors, with the DNA values plotted as a histogram distribution. Quantitative fluorescence measurements of breast carcinoma cells using the acridine-orange stain appeared to be a fairly rapid and simple method for DNA determination as compared to Feulgen DNA analysis. Following cytometric measurements, imprint smears were counterstained by the Giemsa stain and examined by cytomorphologic criteria. With the Giemsa counterstain, the same cytologic preparation could be studied both by quantitative cell measurements and by conventional cytomorphologic criteria. Results are illustrated, and possible implications of the use of this method in the study of tumor behavior and the diagnosis by cytologic methods are discussed.     

Standardized thionin-eosin stain in bronchial cytology. A substitute for hematoxylin-eosin Y staining

A standardized thionin-eosinic acid stain was developed as a quick and highly reproducible staining method for bronchial cytology. Bronchial smears and paraffin-embedded sputum samples were stained with thionin-eosin and with the conventional hematoxylin-eosin Y. Spectral absorption characteristics and staining intensity of thionin-eosin-stained cells were investigated by means of cytophotometry. The staining pattern of thionin-eosin is very close to that of the hematoxylin-eosin stain; the contrast between nucleus and cytoplasm is significantly higher for thionin-eosin. Thionin-eosin can be used for "dye-fixation" of cytologic smears and tissue imprints. Blueing and differentiation (as for hematoxylin-eosin) is not required for thionin-eosin; thus, fixation and staining can be performed within two minutes. The spectral absorption characteristics of thionin-eosin allow reliable automated cytophotometric discrimination of cell nuclei and cytoplasm. The standardized thionin-eosin stain is recommended as a substitute for the hematoxylin and eosin stain in bronchial cytology.     

Evaluation of Papanicolaou stain for studying micronuclei in buccal cells under field conditions

OBJECTIVE: To compare Papanicolaou (Pap) and May-Grünwald Giemsa (MGG) stain as 2 techniques for staining for buccal mucosal cells to detect micronuclei (MN) infield studies. STUDY DESIGN: Eighty cytologic smears (2 per individual) were taken from the buccal mucosa of 40 cigarette smokers recruited at a rural village in Egypt. Forty smears were stained with Pap stain and 40 with MGG stain. All were assessed for cellularity and scored for MN. RESULTS: Pap stain was faster and easier to process and transport in the field study than was MGG stain. Regarding MGG smears, bacteria and cell debris masked the MN as compared to Pap smears, in which the fixative destroyed the bacteria and made the cell boundaries clearly demarcated. Using Pap stain, MN were seen easily in transparent cytoplasm. CONCLUSION: Pap stain is the preferred method infield studies for scoring and detecting MN in cells of buccal mucosa.     

BioPEPR: a system for the automatic prescreening of cervical smears.

A feasibility study has indicated that a Prescion Encoding and Pattern Recognition (PEPR) cathode ray tube prescreening system for cervical smears can be both accurate and fast. Smears are prepared using a syringing technique and are stained with a Feulgen-type nuclear stain and a protein counter-stain. The use of film as an intermediate step between the cells and Bio PEPR allows the scanning of fields as large as 8 x 8 mm. The morphological features of the cells are measured as directed by a hierarchical decision strategy. Additional programs detect artifacts, overlaps, and leukocytes. For clean samples, false positive and false negative rates on the cell level have been obtained that will allow acceptable smear level rates (10% false positive, 1% false negative). These rates have been reached without compromising the required speed goals of 120 to 180 smears per hr. The efficiency of the system is dependent on the quality of the smears. Measurements on a set of 192 routinely prepared smears indicate acceptable false negative rates and a false positive rate of about 18%. A reduction of this rate is expected with small improvements in cell preparation and measuring software, leading to the overall system efficiency required for commercial feasibility.     

Pinacyanol as A Supra-Vital Mitochondrial Stain for Blood

Pinacyanol¹ is an excellent, almost permanent and very selective stain for mitochondria in supra-vital blood preparations. It may be used alone or in combination with neutral red for the study of fresh blood, bone marrow, spleen or lymph node smears. One drop of a 0.1% solution of pinacyanol in absolute alcohol, per cubic centimeter of the same solvent, is a satisfactory dilution for making stain films for blood with an average concentration of cells.     

Vital staining and acrosomal evaluation of bovine sperm

Dried smears prepared from vitally stained sperm were evaluated as a method of simultaneously determining sperm viability and acrosomal morphology. A combination Fast Green FCF-Eosin B stain was used. The stained smears were examined at × 1, 250 using differential interference contrast microscopy (DIC). For comparison, the percentage of sperm with intact acrosomes was also determined from wet smears using DIC. Acrosomal morphology was not altered by the staining procedure, as the percentage of intact acrosomes was similar whether quantitated from wet or stained smears. Absence of eosinophilic staining in the acrosome was used as an indication of sperm viability. The percentage of sperm with unstained acrosomes was highly correlated with the percentage of intact acrosomes quantitated from stained smears. Thus, vital staining provided an indication of sperm viability comparable to acrosomal integrity, a highly reliable technique. The major advantages of using dried stained smears were more thorough examination of individual sperm without sperm activity interference, simultaneous evidence of sperm viability and morphology, and the opportunity to delay evaluation. In addition, diluting spermatozoa in complex or simple media with or without egg yolk or follicular fluid did not interfere with subsequent staining or acrosomal evaluation.     

Detecting mycobacteria in Romanowsky-stained cytologic smears. A case report

BACKGROUND: Cytologic features of mycobacterial infections are granulomatous inflammation with or without caseous necrosis and the demonstration of acid-fast bacilli with special stains. However, immuno-compromised patients might not mount the expected response. CASE: A routinely used Romanowsky (Leishman) stain was used for the presumptive diagnosis of mycobacterial infection in a 30-year-old man with AIDS. The mycobacteria were identified as inclusions, described as "negative images," in the cytoplasm of macrophages in smears of bone marrow aspirate. They were then confirmed to be acid-fast bacilli with Ziehl-Neelsen stain. CONCLUSION: Negative images of mycobacteria may be seen in Romanowsky-stained cytologic smears from patients with immunodeficiency. This is a rapid and cost-effective way of detecting the mycobacteria before more specific results are available. Such a search should be undertaken routinely in all patients suspected to have such infections.     

Performance of monolayered cervical smears in a gynecology outpatient setting in Kuwait

OBJECTIVE: To compare ThinPrep (TP) Papanicolaou smears (Cytyc Corp., Box-borough, Massachusetts, U.S.A.) with matching conventional Papanicolaou (CP) smears for specimen adequacy, cytologic quality, diagnostic accuracy and screening time. STUDY DESIGN: In this prospective study of 1,024 women a split-sample, matched-pair design in favor of CP slides based on single-blind criteria was followed with a smear on a glass slide for CP and the remaining material collected in Preserv-Cyt solution (Cytyc) for a TP smear. A Cytobrush (Medscand, Hollywood, Florida, U.S.A.) was used for smear preparation for CP. TP smears were processed in ThinPrep 2000 (Cytyc). Smears were stained with Papanicolaou stain and were interpreted according to the Bethesda system. RESULTS: The number of satisfactory but limited (SBL) cases with TP were 77 (7.5%) as compared to 127 (12.4%) with the CP method. This reduction in SBL smears with the TP method and consequent increase in satisfactory smears were highly significant (P < .001) by McNemar's test. As regards unsatisfactory smears in discordant pairs, although the number of unsatisfactory smears was higher with TP (41 cases) as against CP (27 cases), the difference was not statistically significant (P < .05). The split-sample method showed a high correlation between the CP and TP diagnoses. TP smears had a significant advantage over CP smears in the reduction in the number of ASCUS and AGUS cases (14 vs. 29) (P < .05) and increased the pickup rate of LSIL, 6 vs. 1. Time taken to screen the TP smears was half that of CP smears. No cases of LSIL or HSIL were missed on TP smears. CONCLUSION: The liquid-based processor significantly improved the adequacy and quality of smears, resulting in fewer recall cases for SBL smears, leading to more definitive diagnoses in atypical cases, increasing the pickup rate of LSILs and reducing the screening time. A machine handling multiple specimens automatically would decrease cost and be an asset to a cytopathology laboratory.     

应用H.E染色的鼻咽癌细胞涂片进行DNA含量测定和EB病毒基因原位杂交的研究

分析鼻咽癌常规 H.E染色细胞涂片分别作 Feulgen染色检测 DNA含量和原位杂交检测 EB病毒编码 RNAs(EBERs)的效果 ;将常规 HE染色的 9例正常鼻咽细胞涂片和 38例鼻咽癌细胞涂片用 1%酸性酒精褪色 ,然后作 Feulgen染色 ,应用图象分析仪测定涂片细胞 DNA含量 ,并将 38例鼻咽癌细胞病例的阳性涂片进行 EBERs原位杂交检测 ;结果显示正常鼻咽细胞均为 DNA二倍体核型 ,38例癌阳性涂片中呈 DNA二倍体者 6例 ,DNA非二倍体者 32例 (84.2 % ) ,癌细胞核 EBERs阳性者 35例 (92 .1% ) ;结果表明 HE染色的鼻咽癌细胞学涂片经褪色后作 Feulgen染色和原位杂交检测 ,能较满意进行 DNA和 EBERs分析 ,表明常规 H.E染色和褪色处理均不影响 Feulgen染色和 EB病毒原位杂交的质量效果。本检测方法可靠、可行 ,适用于常规染色细胞学样本的回顾性研究和随访研究 ,并可用于鼻咽癌可疑病人的诊断和鉴别诊断     

Papanicolaou stain: Is it economical to switch to rapid, economical, acetic acid, papanicolaou stain?

OBJECTIVE: To standardize an inexpensive and rapid Papanicolaou staining technique with limited ethanol usage. STUDY DESIGN: Smears from 200 patients were collected (2 per patient) and fixed in methanol. Half were subjected to conventional Papanicolaou and half to stain ing with rapid, economical, acetic acid Papanicolaou (REAP) stain. In REAP, pre-OG6 and post-OG6 and post-EA36 ethanol baths were replaced by 1% acetic acid and Scott's tap water with tap water. Hematoxylin was preheated to 60 degrees C. Final dehydration was with methanol. REAP smears were compared with Papanicolaou smears for optimal cytoplasmic and nuclear staining, stain preservation, cost and turnaround time. RESULTS: With the REAP method, cytoplasmic and nuclear staining was optimal in 181 and 192 cases, respectively. The staining time was considerably reduced, to 3 minutes, and the cost per smear was reduced to one fourth. The staining quality remained good in all the smears for > 2 years. CONCLUSION: REAP is a rapid, cost-effective alternative to Papanicolaou stain. Though low stain penetration in large cell clusters is a limitation, final interpretation was not compromised.     

Cell blocks from scraping of cytology smear: comparison with conventional cell block

OBJECTIVE: To compare cytomorphology preservation and immunohistochemistry results between conventional cell blocks (CCB) and cytoscrape cell blocks (SCB). STUDY DESIGN: Fine needle aspiration (FNAC) was done in 17 consecutive cases. Air-dried smears for May-Grünwald-Giemsa stain and wet-fixed smear for hematoxylin-eosin (H-E) stain were prepared. Simultaneously another pass was made in each case for preparation of material for CCB. One of the H-E-stained smears was spared for SCB. SCB was compared with CCB for cell morphology. Immunostaining was performed both cell blocks, as well as on FNA smears in 8 cases. Results were evaluated for intensity of staining and percentage of cells showing positivity. RESULTS: CCB and SCB sections showed adequate cellularity in all cases. Morphologic preservation was good in SCB sections. There was good architectural and nuclear preservation in all cases of SCB. Immunostaining results showed better and clear intensity of staining with little background in all cell block cases. CONCLUSION: SCB is a valuable technique in cell blocks from stained FNA smears. The cytomorphologic details are equally good in SCB and CCB. Additional panels of immunostaining can be done on SCB for better diagnosis and classification, particularly in cases in which repeat FNA is not possible.     

Scrape cytology of elastofibroma. Report of a case with diagnostic cytologic features.

BACKGROUND: Elastofibroma is a benign, soft tissue tumor that occurs most frequently in the subscapular area in elderly people. To the best of our knowledge, in only two cases has the cytology been reported. The aim of this report is to describe the characteristic cytologic findings of elastofibroma and to discuss the usefulness of elastin stain in scrape smears. CASE: A 72-year-old female had bilateral masses in the lower subscapular area. Scrape smears from a cut surface of the resected masses revealed abundant, "wormlike" or "braidlike" material with central cores with Papanicolaou stain in an intraoperative consultation. Various-sized, petaloid or crystalloid globules were also present. Those elastic fibers were strongly positive for elastin stain in cytologic preparations. CONCLUSION: Elastofibroma can be diagnosed cytologically, and elastin-stained, scrape cytologic preparation is especially useful in such a case.     

The effect of nonscreening smears on screening smear results: a statistical analysis with its implications for the NHS cervical screening programme

This is a statistical analysis of individual NHS Cervical Screening Programme laboratories screening smear 'pick-up' rates (defined here as percentage low grade and percentage high grade of total adequate smears for ages 20-64 years derived from general practitioners and community clinics) in relation to their nonscreening smear workload proportion (here defined as percentage nonscreening smears of total laboratory workload from all sources for all ages). This was achieved by the use of three one way ANOVA models in order to receive a complete overview of the results. The models were applied to the following: (1) Laboratories with a total workload of less than 15000 general practitioner (GP) and community clinic smears; (2) laboratories with a total workload of greater than 15000 GP and community smears and; (3) all laboratories (i.e. a combination of 1 and 2). The 'test' groups within each of these models comprised three subgroups based on the percentage of laboratory workload that consisted of smears from a nonscreening source. This figure ranged from 2.8% to 82.6%. The subgroups were divided so as to contain approximately the same number of laboratories in each one (172 laboratories in total, 42 with workload < 15000 and 130 with > 15000). The results show that laboratories high and low grade pick-up rates have a positively correlated but variable relationship with the proportion of their workload that consists of nonscreening smears. The results show significance overall at the 5% level for high grade and the 10% level for low grade (high grade at P = 0.045 and low grade at P = 0.071). Significance for laboratories viewing less than 15000 screening smears at the 1% level (high grade P = 0.006 and low grade P = 0.005). They show no significance, however, for laboratories viewing more than 15000 screening smears (high grade P = 0.457 and low grade P = 0.622). There is an intriguing possibility that a greater exposure to abnormal smears results in a greater tendency to detect them. The current data provides no evidence to support the NHS Executive's use of 15000 as a designated figure when quality monitoring and service provision becomes a specific issue. The closure or amalgamation of laboratories with workloads less than this would appear to have no scientific evidence base.     

The use of the Kohn chlorazol black fixative-stain in an intestinal parasite survey in rural Costa Rica

The Kohn one-solution chlorazol black (KCB) fixative-stain was used in the examination of stools from 162 children for intestinal parasites in rural, northern Costa Rica. Many more parasites were found by examining the stained smears than were seen on fresh smears. This was especially true of protozoan parasites. The advantages of the KCB technique are, as follows: (1) its simplicity; (2) the stability of the stain in solution and on slides; (3) the ability to use the stain with carbol-xylol in humid regions; and (4) the metachromatic qualities of the stain.     

Preparation of cells from paraffin-embedded tissue for cytometry and cytomorphologic evaluation

A method is described for the preparation of monolayer smears from paraffin-embedded tissue. The smears are suitable for automated image analysis and DNA measurements while still allowing interpretation of nuclear morphology. The proposed technique uses enzyme treatment and syringing for cell dispersal. The preparation of cell monolayers is performed by cytocentrifugation. After staining the specimens with gallocyanin, nuclear DNA can be measured. Automated DNA measurements using the Leyden Television Analysis System (LEYTAS) showed coefficients of variation of 4.5% for the diploid cell population of suspended benign tissue. After DNA measurements, the specimens are counterstained using orange G and eosin. Since gallocyanin has spectral properties similar to those of hematoxylin, the obtained end product is comparable to specimens stained according to the routinely used Papanicolaou procedure. Using this technique, image cytometry can be applied to paraffin-embedded tissue in combination with conventional cytomorphologic study of the cells.     

A Single solution iron-hematoxylin Stain for Intestinal Protozoa

A single solution iron-hematoxylin stain is described for staining fecal smears rapidly and simply. The stain is prepared from the following solutions: Solution A: 1% hematoxylin in 95% alcohol, prepared by diluting a stock solution of 10% hematoxylin in 95% alcohol. Solution B: Ferric ammonium sulfate (violet crystals), 4.0 g.; glacial acetic acid, 1.0 ml.; concentrated sulfuric acid (sp. gr. 1.8),0.12 ml.; distilled water, 100 ml. Mix equal parts of Solution A and Solution B; allow to stand overnight, filter and use. For maximum length of staining life, store in full, air-tight bottles. To stain fecal smears, fix in Schaudinn's, pass through iodine alcohol to 50% alcohol, stain for three minutes, wash in running tap water 5 to 15 minutes, dehydrate and mount.     

A Single solution iron-hematoxylin Stain for Intestinal Protozoa

A single solution iron-hematoxylin stain is described for staining fecal smears rapidly and simply. The stain is prepared from the following solutions: Solution A: 1% hematoxylin in 95% alcohol, prepared by diluting a stock solution of 10% hematoxylin in 95% alcohol. Solution B: Ferric ammonium sulfate (violet crystals), 4.0 g.; glacial acetic acid, 1.0 ml.; concentrated sulfuric acid (sp. gr. 1.8),0.12 ml.; distilled water, 100 ml. Mix equal parts of Solution A and Solution B; allow to stand overnight, filter and use. For maximum length of staining life, store in full, air-tight bottles. To stain fecal smears, fix in Schaudinn's, pass through iodine alcohol to 50% alcohol, stain for three minutes, wash in running tap water 5 to 15 minutes, dehydrate and mount.     

Expression of p16INK4A in Pap smears containing atypical glandular cells from the uterine cervix

OBJECTIVE: To verify one of the diagnostic dilemmas concerning atypical glandular cells (AGC) by immunocytochemical detection of p16INK4A (p16) applied to routine Pap smears with correlation of follow-up biopsies for improvement of cytologic diagnoses. STUDY DESIGN: The study included 36 Pap smears in AGC diagnostic categories, all of which were correlated histologically. The cytologic diagnoses of AGC were further classified according to the 2001 Bethesda System. All Pap smears were decolorized and immunostained with the primary anti-p16 antibody, clone E6H4. Immunoreactivity for p16 was correlated with histologic sections in a semiblind fashion. RESULTS: Of the 36 smears containing AGC, 22 (61%) were reclassified as general AGC and 14 (39%) as AGC--favor neoplasia. Follow-up biopsies revealed that 15 (42%) cervixes had no obvious abnormalities and that 21 (58%) cases had different cervical lesions. More than half the cases (19/36, 53%) of follow-up biopsies concerning AGC-containing smears represented significant lesions. There was a much higher proportion of significant lesions (13/14, 93%) in AGC--favor neoplasia than those (6/22, 27%) in general AGC cases. Fifteen of 36 (36%) AGC-containing cases were actually squamous abnormalities on follow-up biopsies. p16 Immunocytochemical stain was reactive in 22 (61%) of 36 smears, either weakly/sporadically (2 cases, 6%) or strongly positively (20 cases, 55%). Conversely, 14 (39%) of the smears were negative for p16 and displayed predominantly reactive changes. However, there was 1 case of high grade squamous intraepithelial lesion showing negative immunostaining for p16. From the view-point of clinical significance, this analysis was highly sensitive (sensitivity, 95%) and specific (specificity, 88%) and had favorable positive (90%) and negative (94%) predictive values. CONCLUSION: On the basis of both morphologic and immunostaining patterns, there was a clear association between strong p16 immunostaining of atypical cells in smears and the presence of significant lesions in the cervix except in 1 patient. Similarly, there was a clear association between lack of p16 expression and absence of cervical lesions. p16 Immunocytochemical stain can be applied successfully to conventional Pap smears and may serve as a useful biomarker in diagnoses of AGC-containing smears. This may offer a more objective parameter to help clarify this ambiguous area of gynecologic cytopathology.     

The use of percoll gradients, elutriator rotor elution, and mithramycin staining for the isolation and identification of intraerythrocytic stages of plasmodium berghei

Intraerythrocytic parasites of Plasmodium vinckei and Plasmodium berghei were separated according to their developmental stages using discontinuous Percoll gradients. Contaminating nucleated blood cells such as leukocytes were removed by elutriation centrifugation. The stages were unequivocally identified in smears using a newly developed DNA-specific staining procedure with mithramycin and fluorescence microscopy. This stain can also be used to detect parasites in human blood of very low parasitemias. The combination of methods described has many possible applications in immunologic and biochemical parasite research.     

Cytology of argyrophilic carcinoma of the breast

Aspirations of breast lesions from 57 patients were studied by evaluating Grimelius-stained smears in order to determine the cytologic features of argyrophilic carcinoma and the reliability of argyrophilia as a characteristic of malignancy. The cytologic preparations were compared with histologic material. Sixteen benign lesions, 24 carcinomas correctly diagnosed by cytology and 5 carcinomas with technically inadequate smears were argyrophil negative. Five of 12 carcinomas with equivocal cytology were argyrophilic. There was perfect to case-to-case correlation between argyrophilia seen on histologic slides and on smears. The smears of the 5 argyrophilic carcinomas and 2 of the argyrophil-negative carcinomas with equivocal cytology shared features in common not seen in the other 50 smears: elongated cells with eccentric, round-to-oval nuclei and granular or opaque cytoplasm. These features can alert the pathologist to the possibility of malignancy in smears with equivocal cytology. A positive stain for argyrophilia will further increase the index of suspicion.