Quantitative assessment of various fixatives on nuclear and cytoplasmic areas in oral cytology

Summary Both nuclear and cytoplasmic areas are parameters known to be of significance in the diagnosis of malignancy. However, few studies have assessed the effect of fixation on exfoliative cytology and none has looked at such influences upon oral smears. Hence the method of fixation may influence directly diagnostic cytology. The effect of three methods of fixation upon the nuclear and cytoplasmic areas of cells removed from the buccal mucosa was quantitatively assessed. The three methods employed, prior to Papanicolaou staining, were: direct immersion in diethylether and ethanol (11 v/v), spray fixation (Vale Smear Fix) and air drying. Three smears from each of 21 patients were used, each slide being allocated randomly a, method of fixation. After 24h all smears were processed for Papanicolaou's stain.The nuclear and cytoplasmic areas were calculated using semi-automated image analysis. No significant differences were found in the two areas whichever method of fixation was used.     

Simultaneous detection of T-, B- and D-rosette forming lymphocytes and null cells in humans]

For the identification of T-, B-, and D-rosette-forming lymphocytes and the "null" cells in the human peripheral blood a simultaneous reaction of rosette-forming cells with the use of zymosan-complement, sheep red blood cells, fixation and staining of smears in extraction of the lymphocytes tested with the aid of verographin may be recommended.     

Fixation techniques for fine needle aspiration biopsy smears prepared off site

OBJECTIVE: To identify a simple, cost-effective, reliable fixation method for fine needle aspiration biopsy (FNAB) yielding a specimen suitable for mail transport. STUDY DESIGN: Smears prepared from 59 FNABs of surgical specimens were fixed by continuous fixation in 95% ethanol, spray fixation, air drying, ethanol fixation for either 5 minutes or 4 hours followed by spray fixation, or fixation in 95% ethanol for either 30 minutes or 4 hours followed by air drying. Fixation was graded as unsatisfactory, suboptimal, average, good or excellent. RESULTS: Of smears continuously fixed in ethanol, 96.6% were graded as excellent. Of smears fixed in ethanol followed by spray fixation, 93.2% were excellent irrespective of fixation time; 64.4% of spray-fixed smears were excellent and 27.1% good. Of air dried smears, 93.2% were unsatisfactory or suboptimal; 83.0% of smears fixed in ethanol for 30 minutes and 74.6% of smears fixed for 4 hours prior to air drying were unsatisfactory or suboptimal. CONCLUSION: Fixation of smears in 95% ethanol followed by spray fixation produces excellent results, comparable to those with continuous fixation in ethanol. Spray fixation is generally good but not consistently excellent. Air drying or fixation in ethanol followed by air drying yields unsatisfactory or suboptimal results in most cases.     

Factors affecting the immunoperoxidase demonstration of intracellular immunoglobulins and J chain from cytocentrifuged cell smears

Immunohistochemical methods were used to study 1) the optimum fixation conditions for the preservation of human J chain and immunoglobulin (Ig) immunoreactivity and 2) the relation of J chain synthesis by plasmablasts and plasma cells to Ig synthesis in cell smears of cultured human peripheral blood lymphocytes stimulated with pokeweed mitogen (PWM). J chain was demonstrated using the indirect immunoperoxidase method, and intracellular Ig was demonstrated with the unlabeled antibody--enzyme method. In the sequential double staining procedure, J chain was demonstrated using the indirect immunoperoxidase method followed by the demonstration of Ig with the direct immunofluorescence method. Optimum preservation of J chain immunoreactivity was obtained with fixation in neutral buffered formalin at 22 degrees C for 5 min followed by immediate immunoperoxidase staining. False negative results were seen when the slides were stained 2 weeks after fixation. In PWM-stimulated smears, J chain appeared on day three, simultaneously with or after the onset of Ig synthesis. In double stained smears most IgG-positive cells also showed immunoreactivity for J chain from the third day on.     

Preliminary observation of blood cells and hematopoietic organs in Lutjanus herenbergi and Lutjanus flaviflammus

The morphology of differentiated and differentiating cells of the red and white series in Lutjanus herenbergi and in Lutjanus flaviflammus is described. Early stages of red and white blood cells may be found only in smears of hemopoietic organs. Polychromatic erythroblasts, myelocytes and lymphoblasts may also occasionally be found in blood smears. Mature blood cells may be found both in blood smears and in hemopoietic organs. Differential white cell counts seem to demonstrate that the granulocytic series elements are the most common leukocytes in blood smears. Almost all granulocytes may be classified in the first three Arneth classes. An analysis of hemopoietic organs in these species was also performed. It was found that the only organs carrying on a hemopoietic function are the kidney and the spleen. The kidney is essentially a site of granulocytic differentiation while the spleen is a lymphopoietic organ. An erythropoietic activity may generally be observed in the kidney although weak erythropoietic activity may at times be found in the spleen.     

On the cytochemical demonstration of glycogen in neutrophil granulocytes: periodic acid-Schiff reaction and diastase (amylase) digestion test (author's transl)]

The results of the present investigation indicate clearly that treatment of blood smears with diastase resp. amylase is unsuitable to identify glycogen in neutrophil granulocytes. This may be attributed to the contamination with proteases of commonly used preparations of diastase resp. amylase. Thus strong PAS-reactive material which presents most probably not glycogen but PAS-positive glycoproteins may be eliminated by the proteolytic activity of the contaminants. - In detail it has been shown that susceptibility resp. resistance of the PAS-positive material against treatment with diastase resp. amylase is highly dependent on both type of fixation and fixation time: Fixation with formol free absolute alcohol (ethanol, methanol), leads also after prolonged fixation time to a complete loss of PAS-staining after preliminary treatment with diastase resp. amylase. On the other side after fixation with formol containing fixatives (for example formol/ethanol and acetic acid/formol/ethanol) only after short term fixation practically a complete loss of PAS-staining material is observed. However, after long term fixation more or less complete resistance of the PAS-stainable material against treatment with diastase resp. amylase has been found.     

Survival of tubercle bacilli in heat-fixed and stained sputum smears

We used a slide culture technique to detect tubercle bacilli surviving in sputum smears (n=46) after conventional heat fixation and Ziehl-Neelsen staining. In all heat-fixed sputum smears, tubercle bacilli survived after time 0 (n=22), 24 h (n=7), 48 h (n=7), 72 h (n=4), and seven days (n=6). None of the stained sputum smears showed growth on slide cultures. Viable tubercle bacilli remaining in heat-fixed sputum smears for at least seven days may present an infection risk to laboratory staff. Thus, sputum smears should be stained immediately by the Ziehl-Neelsen method or stored in a safe container to avoid transmission of tuberculosis.     

Methods for Accelerating the Fluorescent-Antibody Test for Rabies Diagnosis

The time required to perform the fluorescent-antibody test for rabies was reduced by eliminating acetone fixation of the brain impressions and by incubating the conjugate-impression reaction at room temperature for only 10 min. Elimination of the preliminary acetone fixation had no effect on the diagnosis of impression smears from 246 mammalian brains by immunofluorescence. Staining at 37 C for 30 min and staining at room temperature for 10 min were found to be equally effective in the examination of impression smears from 161 brain samples. The procedure, as modified, shortens the time required for the diagnosis of rabies by immunofluorescence from about 5.5 hr to approximately 45 min.     

Bile duct brushings cytology – improving sensitivity of diagnosis using the ThinPrep® technique: a review of 113 cases

OBJECTIVE: Common bile duct (CBD) brushings have been recognized as a technique of moderate sensitivity and high specificity in identifying carcinoma of the ampulla and pancreatico-biliary regions. This study evaluated the increase in sensitivity of this technique using the ThinPrep technique of specimen preparation when compared with conventional cytology smears. METHODS: A total of 113 bile duct brushings were included in the study (38 conventional smears and 75 slides prepared using the ThinPrep technique). All slides were reviewed by one cytologist. Five categories of reporting were used: inadequate, negative, atypia, suspicious and malignant. RESULTS: The inadequate category of reporting disappeared in the ThinPrep group with improved specimen fixation and preparation and hence reduced artefact. Sensitivity of diagnosis of malignancy increased from 39% in conventional smears to 53% in the ThinPrep group. Specificity, positive and negative predictive values and accuracy were 100%, 100%, 60% and 68% for conventional smears and were 100%, 100%, 60% and 72%, respectively, for ThinPrep specimens. CONCLUSIONS: ThinPrep technique was associated with increased sensitivity of diagnosis, in part due to improved specimen fixation and reduced artefact. Cytology of bile duct brushings is an important diagnostic tool for sites from which it can be difficult to obtain a histology biopsy. It may therefore provide the only opportunity for tissue diagnosis of carcinoma from these sites, hence the importance of optimizing sensitivity.     

Variables Influencing Results, and the Precise Definition of Steps in Gram Staining as a Means of Standardizing the Results Obtained

Results of a Gram staining procedure varied with modifications of each of the steps involved. The best Gram differentiation was obtained when crystal violet and iodine solutions of high concentrations were used, and when n-propyl alcohol was used as the decolorizer. The decolorization step must be carefully quantitated, and one of the most important variables observed was whether a slide was brought into the decolorizer wet, or dry. Dry slides took 6 to 12 times as long to decolorize as wet. Wash steps, following crystal violet, and following the decolorizer, also greatly influence results by causing Gram-positive organisms to appear to be Gram-negative. The results indicated that Gram-stain procedures should not be varied to suit the whims of individual operators, and that each step could be specifically defined both as to the reagent used, and the procedure to be followed.

The followng Gram procedure is recommended for heat-fixed bacterial smears on glass slides. Flood the slide with Hucker's crystal violet for 1 ruin. Wash for 5 sec by dipping into tap water running into a 250 ml beaker at a rate of 30 ml per sec Rinse off the excess water with Burke's iodine, flood the slide with this solution for 1 min, then wash 5 sec in tap water as above. Decolorize by passing the wet slide through 3 (75 × 25 mm) Coplin dishes containing n-propyl alcohol, decolorize 1 min in each dish for a total of 3 min. Wash 5 sec in tap water as above, rinse off the excess water with 0.25% safranin, then flood the slide with this solution for 1 min. Wash as above, blot dry, and examine. An alternate procedure for decolorization would be to use either 95% n-propyl alcohol or 95% ethyl alcohol, but shorten the decolorization time to 30 sec per dish for a total of 1.5 min. After 10 slides, the decolorizer in the first dish should be replaced by fresh. This dish is then placed last in the sequence, with dish No. 2 moved to the No. 1 position.     

Methods of cytologic smear preparation and fixation. Effect on the immunoreactivity of commonly used anticytokeratin antibody AE1/AE3

OBJECTIVE: To evaluate the effect of fixation and methods of cytologic smear preparation on the immunoreactivity of commonly used anticytokeratin antibody AE1/AE3. STUDY DESIGN: Scrape cytology smears and formalin-fixed, paraffin-embedded tissue sections (FPTS) of 20 unfixed, fresh specimens submitted for intraoperative consultation were studied by the immunoperoxidase method. In addition to the morphologic examination, the smears and FPTS were evaluated for intensity and proportion scores. For each specimen, two scrape cytology smears were wet fixed in 95% ethanol, and 12 smears were air dried without fixation. Air-dried smears were either postfixed after rehydration in saline or fixed directly without rehydration by one of the three fixatives: alcoholic formalin, 95% ethanol with 5% acetic acid or 95% ethanol. RESULTS: Both intensity and proportion scores were higher with rehydrated, air-dried smears as compared to those without rehydration and were comparable to those with wet-fixed smears and FPTS. In the rehydrated group, the optimum results were achieved when the smears were postfixed with alcoholic formalin. CONCLUSION: The method of preparation and fixation had variable effects on the immunoreactivity of anticytokeratin antibody AE1/AE3. The optimum results were achieved with saline-rehydrated, air-dried smears post-fixed in alcoholic formalin. To evaluate the role of inter-sample variation, further, larger studies are recommended on this and other antibodies before applying them to different types of cytologic smears.     

Blood parasites of two Costa Rican amphibians with comments on detection and microfilaria density associated with adult filarial worm intensity

The 2 objectives of this study were: (1) to compare parasite detectability in blood smears obtained from toe-clips versus the heart from amphibian hosts; and (2) to test whether microfilariae density is correlated with adult filarial worm intensity. We examined blood parasites of 2 species of amphibians, Rana vaillanti (n = 45) and Eleutherodactylus fitzingeri (n = 36), from Costa Rica collected during the summer of 2003. Separate blood smears were obtained from toe-clips and the heart during necrospy. Eight species of blood parasites were identified from R. vaillanti and 1 from E. fitzingeri. Each parasite species was counted in a 2 x 2.2-cm2 area on each blood smear, and the density of host red blood cells (RBCs) was estimated using a sub-sampling approach, allowing parasite infections to be expressed as individuals per RBC. The detection failure rate for toe-cut smears ranged from 71-100% (x = 92.3%) and from 0-9% (x = 2.4%) for heart smears, depending on parasite species. The density of RBCs was significantly higher in smears produced from heart samples and may explain the differences in detectability. Foleyellides striatus microfilariae densities (per RBC) were significantly correlated with adult female worm intensity (R2 = 0.32, P = 0.011).     

Image cytometric measurements of diploid,triploid and tetraploid fish erythrocytes in blood smears reflect the true dimensions of live cells

Comparative image cytometry of erythrocytes of diploid and triploid tench Tinca tinca L. and evolutionary tetraploid sterlet Acipenser ruthenus L. was performed on whole live unstained cells, live cells with stained nuclei and on stained fixed whole cells and their nuclei to test if erythrocyte measurements made from blood smears reflect the true dimensions of live cells. Nuclear area and perimeter were the best ploidy level predictors distinguishing accurately among live and fixed diploid, triploid and tetraploid cells, without significant differences between live and fixed cells within a ploidy level. Redundancy analysis revealed insignificant marginal effect of fixation (explained 2.3% of variation, F=0.804), whereas the effect of ploidy level was highly significant (explained 50.6% of variation, F=34.874). The erythrocyte measurements of diploid, triploid and tetraploid fish erythrocytes and their nuclei made from blood smears reflect the true dimensions of live cells, and the fixation procedure did not substantially affect their predictive value for ploidy level determination.     

The Irrigation Smear—A New Cytodiagnostic Technique for the Detection of Cancer of the Uterine Cervix

Using the Davis cytopipette, cytologic smears were prepared from 2014 patients; 1367 of these specimens were obtained by the patients themselves. The series included 57 cases of carcinoma or atypia of the cervix, and 50 (88%) of these cases were found to have abnormal cells in the irrigation smear.Cytopipette samples were obtained by a nurse from 647 Eskimos, but cell preservation in this group was not satisfactory because of a delay of several weeks in preparing the smears. Accurate results depend also on specific training of the personnel reading the smears because fewer cells may be present in these smears than in cervical scrape smears.The irrigation smear is recommended as a reasonably accurate method of screening women for cancer of the cervix if they are not being examined regularly by the cervical scrape method. Hospital admissions of females may be a fruitful source of such cases.     

A simple method for observation of phagocytosis on bacterial thin-layer

A simple method was developed to visually present the phagocytic activity of leukocytes by using adherent Staphylococcus aureus cells and blood applied on a plastic dish. When heparinized blood was applied on thin-layer of heat-killed S. aureus cells on the plastic dish, plaques due to the phagocytic activity of leukocytes were observed with a microscope under a low magnification. Fewer and smaller plaques were observed when plasma-deprived rather than whole blood was used. Some analyses were made in respect to the fundamental conditions required for optimal results. This method was considered to be useful for conveniently evaluating the serum opsonin activities and phagocytic function of leukocytes in various kinds of diseases.     

The Effect of Organic Solvents on the Appearance of Bacterial Nuclei

Treatment of bacterial smears with organic solvents was found to produce a typical appearing nuclei which could lead to false interpretation of nuclear events. The crystal violet nuclear stain, which does not utilize organic solvents or acid hydrolysis, was used as a basis of comparison. Acid hydrolysis also was observed to affect the appearance of the nucleus. It is concluded that caution should be used in interpreting nuclear structure and activity in bacterial cells, especially when organic solvents or acid hydrolysis are involved in the staining technic.     

An immunogold-silver staining method for detection of cell surface antigens in cell smears

We developed an indirect immunogold-silver staining method for detection of leukocyte cell surface antigens in cell smears. Air-dried and fixed cytocentrifuge preparations or smears of peripheral blood leukocytes were incubated with monoclonal antibodies (MAb) and colloidal gold-labeled secondary antibodies. The preparations were post-fixed and silver enhancement was performed. The smears were counterstained with May-Grunwald-Giemsa and examined in brightfield light microscopy. The morphology of the cells was well preserved. Leukocytes reacting with the MAb showed black granules on their surface membranes. The intense immunostaining and the low background allowed a rapid enumeration of the positive cells. The labeling could be detected with high sensitivity by epipolarization microscopy. This immunogold-silver staining method was used to quantify T- and B-lymphocytes and natural killer cells in buffy coat smears of normal adult blood. These lymphocyte subsets correlated well with those obtained in smears with the alkaline phosphatase-anti-alkaline phosphatase (APAAP) method and with those found by labeling of mononuclear cells in suspension with immunogold-silver staining. This immunogold-silver staining method forms a good alternative to immunoenzyme methods for study of hematologic cells. In addition, it could be a general procedure for detection of cell surface antigens in all kinds of cell smears.     

Entamoeba gingivalis in sputum smears

Entamoeba gingivalis is a common parasite of the human buccal cavity whose rare appearance in Papanicolaou-stained sputum smears may be missed. Two such cases are described, including the morphologic features of this ameba. The trophozoites were seen to phagocytize leukocytes as well as red blood cells, in distinction to E. histiolytica, which phagocytizes only red blood cells and also can cause pulmonary abscesses. The concomitant finding of Actinomyces sp. organisms in one patient reinforces the possible symbiotic relationship between the two organisms, as has been suggested for their appearance in other extraoral sites, such as the female genital tract.     

Endocyte endometrial smears in the cytodiagnosis of endometrial carcinoma

The cytologic diagnosis of endometrial cancer using material obtained with the Endocyte endometrial sampler was assessed for 874 patients. The samples obtained were smeared directly on slides for fixation and staining; the smears were more difficult to assess than cervicovaginal smears, however, due to the presence of blood, the small size and density of the cells and the flattened three-dimensional architecture of the tissue fragments obtained. Only 8.2% of the samples were classified as inadequate; repeat sampling in some of those cases produced diagnostic material. All 12 cases of carcinoma (including one case in a woman less than 40 years of age) were diagnosed by cytology as malignant; however, the original cytologic sample in one of those cases was inadequate. For the diagnosis of benign versus malignant, cytology had a sensitivity of 92%, a specificity of 100% and predictive value of 100%. Cytology also diagnosed as suspicious the smears from 5 of 13 cases of endometrial hyperplasia and 2 of the 9 cases of endometrial polyps. The cytologic findings for benign and malignant samples are described and illustrated in detail. Relative to other endometrial sampling devices, the Endocyte is inexpensive and was easily used by the gynecologist and well tolerated by the patients, with no complications and minimal discomfort.