Staining apoptosis in paraffin sections. Advantages and limits

OBJECTIVE: To describe the advantages and limits of apoptosis detection on paraffin sections by TdT-mediated dUTP nick end labeling (TUNEL). STUDY DESIGN: Two hundred sixty-five paraffin-embedded samples from malignant and benign human tissue were analyzed by TUNEL. Also, biparametric analysis of apoptosis and proliferation index (MIB-1), apoptosis, cytokeratin or leukocyte common antigen was performed. RESULTS: Our preliminary conclusions are as follows. The limits are that this labelling method might detect cells that have not shown DNA fragmentation specific for apoptosis only. The technique is extremely sensitive to the degree of proteolytic digestion. TUNEL identifies nuclei in areas of necrosis. Indeed, the staining of necrotic areas of tissue with the in situ labelling method should not cause confusion since simple morphologic examination of tissues will suffice to identify areas of necrotic cells. The advantages are that TUNEL is a method of simplifying the identification of apoptotic nuclei in routinely processed tissue sections, maintaining topography. It allows retrospective studies and biparametric analysis of cell death and proliferation on the same sample. Furthermore, with biparametric stain, it could better identify the origin (epithelial, mesenchymal, and so on) of apoptotic cells. CONCLUSION: TUNEL is a good method of detecting apoptotic nuclei in fixed, embedded tissue sections, but, because of the limits of the method, the results should be interpreted in conjunction with apoptosis assessment by routine light microscopy.