Application of modified ultrafast Papanicolaou stain in cytology of various organs

Modification of Rapid Papanicolaou Stain with Phloxine: A Study Assessing the Utility in Gynecological Smears

Background

Rapidity and reliability are the major advantages of cytopathology in tumor diagnosis. The need for minimal turnaround time for assessing cytological smears has encouraged innovations in staining techniques that require lesser staining time with unequivocal cell morphology. Rapid Pap staining was introduced as a hybrid to conventional Pap stain. It improves staining quality, gets over the staining time in restriction, and is a more efficient technique financially. In the present study, a modified staining technique was adopted where phloxine is added as one of the cytoplasmic stain components in rapid Pap stain kits.

Objective

The aim of this study was to assess whether the modification of the existing procedure by adding phloxine as one of the components of the cytoplasmic stain intensifies the cytoplasmic differentiation and cytoplasmic staining in gynecological smears.

Materials and Methods

This was a prospective study done on 50 cases of gynecological smears. Two smears were collected from each patient and fixed in 100% propanol and stained with the rapid Pap stain kit procedure and modified rapid Pap stain with phloxine. Slides were then analyzed by two pathologists blinded to the staining method used. Five parameters were considered and scored (background, cell morphology, nuclear staining, cytoplasmic differentiation, and cytoplasmic staining). The quality index for each method was calculated by finding out the ratio of the actual score obtained to the maximum score possible.

Results

Both the staining methods had comparable results. For both pathologists, the quality index calculated for modified Pap stain was found to be marginally higher than the quality index for rapid Pap. The mean quality index was comparable for modified Pap (0.91) and rapid Pap (0.89).

Conclusions

The efficacy of modified Pap stain with phloxine to distinctly stain the cytoplasm is comparable with that of rapid Pap stain. In addition, the intensity of staining can be enhanced with little cost outlay, and this can be especially beneficial in low-resource settings.

Cost and pollution by the use of xylene in cervical cytology in four Peruvian hospitals

Background: Cytological samples are cleared with xylene in two or three baths during a Pap test, however, this solvent has a high degree of toxicity, and being a controlled reagent infers high costs for its purchase and implications for environmental pollution. We estimated the impact of xylene during the Pap test in terms of the number of liters and cost of two baths of xylene, and also estimated the impact with three baths  Methods: This cross-sectional study was carried out in four hospitals of EsSalud in Peru in two stages. First, the analysis of the impact due to the use of two baths of xylene was conducted during the period 2015-2019, and second, the estimates were calculated based on the assumption of three baths of xylene for the years 2020-2025. The assumption was based on the recommendations of the 2018 EsSalud cytology guideline. The monthly amount of xylene was ~10 liters per bath/month and the cost per liter was estimated at 8.13 USD (27 soles).  Results: For the staining of 594,898 cytology tests, 7,848 liters of xylene were necessary, resulting in a cost of 60,861 USD (202,068 soles) during the period 2015-2019. The estimates showed a maximum assumption of 9,483 liters and 77,110 USD (256,040 soles) for the use of three baths of xylene in the four EsSalud hospitals (p = 0.0025) during the period 2020-2025.   Conclusions: We determined that there was a high economic impact of using xylene with two baths from 2015 to 2019 and a dramatic increase in costs with the possible use of three baths of xylene in the Pap test for the following five years.

Cost and pollution by the use of xylene in cervical cytology in four Peruvian hospitals

Background: Cytological samples are cleared with xylene in two or three baths during a Pap test, however, this solvent has a high degree of toxicity, and being a controlled reagent infers high costs for its purchase and implications for environmental pollution. We estimated the impact of xylene during the Pap test in terms of the number of liters and cost of two baths of xylene, and also estimated the impact with three baths  Methods: This cross-sectional study was carried out in four hospitals of EsSalud in Peru in two stages. First, the analysis of the impact due to the use of two baths of xylene was conducted during the period 2015-2019, and second, the estimates were calculated based on the assumption of three baths of xylene for the years 2020-2025. The assumption was based on the recommendations of the 2018 EsSalud cytology guideline. The monthly amount of xylene was ~10 liters per bath/month and the cost per liter was estimated at 8.13 USD (27 soles).  Results: For the staining of 594,898 cytology tests, 7,848 liters of xylene were necessary, resulting in a cost of 60,861 USD (202,068 soles) during the period 2015-2019. The estimates showed a maximum assumption of 9,483 liters and 77,110 USD (256,040 soles) for the use of three baths of xylene in the four EsSalud hospitals (p = 0.0025) during the period 2020-2025.   Conclusions: We determined that there was a high economic impact of using xylene with two baths from 2015 to 2019 and a dramatic increase in costs with the possible use of three baths of xylene in the Pap test for the following five years.

Cost and pollution by the use of xylene in cervical cytology in four Peruvian hospitals

Background: Cytological samples are cleared with xylene in two or three baths during a Pap test, however, this solvent has a high degree of toxicity, and being a controlled reagent infers high costs for its purchase and implications for environmental pollution. We estimated the impact of xylene during the Pap test in terms of the number of liters and cost of two baths of xylene, and also estimated the impact with three baths  Methods: This cross-sectional study was carried out in four hospitals of EsSalud in Peru in two stages. First, the analysis of the impact due to the use of two baths of xylene was conducted during the period 2015-2019, and second, the estimates were calculated based on the assumption of three baths of xylene for the years 2020-2025. The assumption was based on the recommendations of the 2018 EsSalud cytology guideline. The monthly amount of xylene was ~10 liters per bath/month and the cost per liter was estimated at 8.13 USD (27 soles).  Results: For the staining of 594,898 cytology tests, 7,848 liters of xylene were necessary, resulting in a cost of 60,861 USD (202,068 soles) during the period 2015-2019. The estimates showed a maximum assumption of 9,483 liters and 77,110 USD (256,040 soles) for the use of three baths of xylene in the four EsSalud hospitals (p = 0.0025) during the period 2020-2025.   Conclusions: We determined that there was a high economic impact of using xylene with two baths from 2015 to 2019 and a dramatic increase in costs with the possible use of three baths of xylene in the Pap test for the following five years.

Prospective comparison of cytological specimen adequacy assessment by different rapid staining techniques for rapid on-site evaluation in fine needle aspiration cytology and their cost-effectiveness

OBJECTIVE

Rapid on-site evaluation (ROSE) is a technique beneficial in determining the adequacy of the samples, thereby increasing the diagnostic yield, useful in triage of specimens for ancillary studies and can also help determine a preliminary diagnosis in emergency cases. The different rapid stains for on-site evaluation described in the literature are diff quik, toluidine blue (TB), brilliant cresyl blue (BCB), ultra-fast Pap stains, and rapid hematoxylin and eosin (H&E). This study was undertaken as there is sparse literature regarding the best and the most cost-effective rapid stain.

METHOD

Fine needle aspiration samples from 200 patients with palpable swellings in easily accessible regions were taken. Smears stained by rapid and routine stains were assessed based on four parameters, with provisional diagnosis on the rapid stained smears. A comparative analysis of the advantages and disadvantages of the rapid stains was carried out with appropriate statistical tests with the routinely stained smears as gold standard.

RESULTS

There was adequate material in 100% of ROSE smears. rapid pap stained smears showed well preserved cytoplasmic details, nuclear details, and background details. The time taken was least with TB and BCB being 5 s each. The most cost-effective was found to be TB.

CONCLUSIONS

We conclude that TB is the most cost-effective, quick, least labor-intensive, and reliable rapid stain for ROSE especially in resource-poor settings.

Eco-Pap: The Ecological Modification of the Papanicolaou Stain for Sustainable Cervical Cancer Diagnosis

OBJECTIVES

To validate the ecological modification of the Papanicolaou stain (Eco-Pap) for the diagnosis of cervical cancer.

STUDY DESIGN

A prospective study was performed at the Mother and Child "San Bartolomé" Hospital, Lima, Peru. Reagent handling strategies were divided into three phases: we used (1) Harris progressive hematoxylin (for nuclear staining), (2) a polychromatic solution (a mix of EA-36/Orange G-6 to suppress the use of several alcohol baths), and (3) direct mounting (with Entellan® solution). The cellular details were analyzed by the staining quality index, an external quality control, and the Bethesda System 2014.

RESULTS

We evaluated 72,901 cervical smears stained with the Eco-Pap. The validation of the Eco-Pap against the conventional Pap stain was optimal (κ = 0.89; 95% CI: 0.87-0.92), showing a sensibility and specificity of 88.3% (95% CI: 85.1-90.0) and 98.7% (95% CI: 98-99.2), respectively. The Eco-Pap dramatically reduced the environmental pollution caused by 72 L of xylene, hydrochloric acid, and ammonia (6 L each) and mercury oxide.

CONCLUSION

The Eco-Pap is an innovative and efficient staining method reducing the use of toxic reagents with carcinogenic potential during cervical cancer screening by exfoliative cytology.

Comparative Assessment of Conventional Papanicolaou and Modified Ultrafast Papanicolaou Stains in Fine Needle Aspiration Samples and Body Fluids

Background

Conventional Papanicolaou (Pap) stain has undergone many modifications; of these, ultrafast Pap stain is the most popular as it shortens the turnaround time of reporting. Application of modified ultrafast Pap (MUFP) stain in the evaluation of fine needle aspiration (FNA) samples and body fluids are scanty.

Aim

To evaluate the utility of MUFP stain in various FNA samples and body fluids and compare the findings with those of conventional Pap stain.

Materials and Methods

In this cross-sectional study, two wet-fixed and two airdried smears from each sample [301 samples (255 FNA samples and 46 body fluids)] were prepared and stained by the conventional Pap and MUFP stains, respectively. Concordant and discordant rate was calculated. Quality index (QI) of MUFP stain was assessed by background, overall staining, cell morphology, and nuclear characteristics. MUFP-stained smears were also categorized into excellent, good, and fair.

Results

The concordance rate for MUFP stain was 100%. QI of MUFP stain for breast, thyroid, lymph node, soft tissue, salivary gland, and body fluids was 0.9, 0.93, 0.95, 1, 0.94, and 1, respectively. Excellent quality of stain was noted in 53.2% and good in 24.6% of the cases allowing easy diagnosis. In 22.2% of fair cases, diagnosis was possible with some difficulties.

Conclusion

Our study concluded that MUFP stain could be considered as a rapid and reliable diagnostic tool and can be applied on a regular basis in FNA samples and body fluids to offer immediate diagnosis. However, caution should be taken while reporting certain MUFP-stained smears to avoid over/under diagnosis.

Utility of Modified Ultrafast Papanicolaou Stain in Cytological Diagnosis

INTRODUCTION

Need for minimal turnaround time for assessing Fine Needle Aspiration Cytology (FNAC) has encouraged innovations in staining techniques that require lesser staining time with unequivocal cell morphology. The standard protocol for conventional Papanicolaou (PAP) stain requires about 40 minutes. To overcome this, Ultrafast Papanicolaou (UFP) stain was introduced which reduces staining time to 90 seconds and also enhances the quality. However, reagents required for this were not easily available hence, Modified Ultrafast Papanicolaou (MUFP) stain was introduced subsequently.

AIM

To assess the efficacy of MUFP staining by comparing the quality of MUFP stain with conventional PAP stain.

MATERIALS AND METHODS

FNAC procedure was performed by using 10 ml disposable syringe and 22-23 G needle. Total 131 FNAC cases were studied which were lymph node (30), thyroid (38), breast (22), skin and soft tissue (24), salivary gland (11) and visceral organs (6). Two smears were prepared and stained by MUFP and conventional PAP stain. Scores were given on four parameters: background of smears, overall staining pattern, cell morphology and nuclear staining. Quality Index (QI) was calculated from ratio of total score achieved to maximum score possible. Statistical analysis using chi square test was applied to each of the four parameters before obtaining the QI in both stains. Students t-test was applied to evaluate the efficacy of MUFP in comparison with conventional PAP stain.

RESULTS

The QI of MUFP for thyroid, breast, lymph node, skin and soft tissue, salivary gland and visceral organs was 0.89, 0.85, 0.89, 0.83, 0.92, and 0.78 respectively. Compared to conventional PAP stain QI of MUFP smears was better in all except visceral organ cases and was statistically significant. MUFP showed clear red blood cell background, transparent cytoplasm and crisp nuclear features.

CONCLUSION

MUFP is fast, reliable and can be done with locally available reagents with unequivocal morphology which is the need of the hour for a cytopathology set-up.

Modified ultrafast Papanicolaou staining technique: A comparative study

Introduction:

Ultrafast Papanicolaou stain (UFP) was introduced as a hybrid of Romanowsky and Papanicolaou (PAP) stain. It enhances the quality and reduces the time. In the present study, a modified staining technique was adapted where Gill's Hematoxylin was replaced by Harris Hematoxylin.

Aims:

The aim of the study was to assess the use of the modified ultrafast Papanicolaou (MUFP) stain for fine needle aspiration cytology (FNAC) of head and neck swellings in comparison with the routine PAP stain, hematoxylin and eosin (H and E), and Giemsa.

Materials and Methods:

Forty FNACs of head and neck swellings were collected. FNAC procedure was performed by standard method; two smears were fixed in 95% propanol and stained with PAP and H and E. Two smears were air dried, 1 was stained with Giemsa, and 1 was rehydrated with normal saline, fixed in alcoholic formalin, and stained with MUFP. Four parameters were considered and scored background, cell morphology, nuclear staining, and overall staining pattern).

Results:

The quality of MUFP smears were better when compared to routine PAP, H and E, and Giemsa, and was statistically significant by Wilcoxon matched pair test.

Conclusions:

MUFP stain in comparison to routine PAP, H and E, and Giemsa provides an excellent and suitable alterative in cytological staining for the study of various organs.

Environmental Performance of Xylene, Hydrochloric Acid and Ammonia Solution During Pap Stain for Diagnosing Cervical Cancer

BACKGROUND

Little importance has been placed on sustainability of the Papanicolaou (Pap) stain, the gold standard for the diagnosis of cervical cancer, for global environmental health. The standard Pap stain uses environmentally toxic and carcinogenic reactants such as xylene, hydrochloric acid and ammonia solution.

OBJECTIVES

To eradicate the use of environmentally toxic and carcinogenic reactants through the validation of the Ecologic Papanicolaou (Eco-Pap) test.

METHODS

Reagent handling strategies were divided in three phases: used Harris' progressive hematoxilin, polychromatic solution and direct mounting that were analyzed by PEED-Cytology, Staining Quality Index (ICT) and the Bethesda system 2014.

RESULTS

A total of 52,319 Pap smears stained with Eco-Pap were admitted (ICT=0.91). Validation of the Eco-Pap versus conventional staining was optimal (Kappa =0.89) and the sensitivity and specificity of the method were 57% and 98%, respectively. Eco-Pap reduced the environmental contamination produced by xylene (66 liters), hydrochloric acid and ammonia (5.5 liters each) over nine months, and all diagnoses coincided with the cytological details.

CONCLUSIONS

The Eco-Pap is an innovative method that transforms Pap testing into a sustainable and supportable technology.

Comparison of Ultrafast Papanicolaou Stain with the Standard Papanicolaou Stain in Body Fluids and Fine Needle Aspiration Specimens

INTRODUCTION

Most cytology laboratories in all Gulf countries including Oman, use the standard papanicolaou (PAP) method to stain various cytological specimens. The aim of this study was to investigate the possible application of ultrafast PAP (UF-PAP) method in cytology laboratory.

MATERIALS AND METHODS

Samples from 46 patients containing 26 body fluids and 20 fine needle aspirations (FNAs) (9 thyroids and 11 breasts) were collected. Two air dried and two wet smears from each sample were prepared and stained by UF-PAP and the standard PAP stains, respectively. Background, nuclear staining, cell morphology, and overall staining were independently reviewed by two cytoscreeners.

RESULTS

In all cases of FNA, UF-PAP stain gave a good score for the background, nuclear staining, cell morphology, and overall staining when compared with the standard PAP method. Although the correct diagnosis was made in all cases of body cavity fluids cases except in one case, UF-PAP stain gave a fewer score in the assessment of body cavity fluid samples.

CONCLUSION

The findings of this study support the use of UF-PAP method in cytology laboratory with a high emphasis on FNA samples.

Validation of the Modification of the Prolonged Papanicolaou Stain for the Diagnosis of Cervical Cancer

OBJECTIVES

To validate the modification of the prolonged Papanicolaou stain based on the quality control of time, units and staining stages (micro- and macroscopic), and on the stain reactivation based on the control.

STUDY DESIGN

A prospective study was performed on 125,358 cervical smears in Lima (Peru). The microscopic quality control included evaluating the cytological characteristics through the staining quality index (SQI) and the quality criteria for samples described by the Bethesda System (TBS). The macroscopic quality control is based on the interslide staining as a set corresponding to a poststaining vertical angle. The stains were reactivated with the addition of 0.15 and 2 g of phosphotungstic acid for Orange G and EA-50, respectively.

RESULTS

Both the nonneoplastic and the neoplastic findings comply with the quality criteria of the TBS (SQI value = 0.94). The yield per battery of staining fluctuated between 5,616 and 17,954 Pap smears, and the reactivation of stains produced a stain yield of up to four times the initial amount of the smears, saving USD 5,598.88 from 2013 to 2014.

CONCLUSION

The modification of prolonged Papanicolaou staining is an excellent alternative, with a cost-benefit ratio that generates savings and a higher yield per battery of staining.

Comparison of modified ultrafast Papanicolaou stain with the standard rapid Papanicolaou stain in cytology of various organs

BACKGROUND

Since the first introduction of Papanicolaou (Pap) stain in 1942 there have been many modifications. Of these, the Ultra-Fast Pap stain has become popular. This technique was further modified in India as many of the reagents were not available in our country. Our study was conducted by adapting this modified staining technique which involves the replacement of Gill's hematoxylin with Harris hematoxylin.

AIMS

The aim of our prospective study was to assess the use of the modified Ultra-Fast Pap stain (MUFP) for fine needle aspiration cytology (FNAC) of various organs in comparison with the standard rapid Pap stain.

MATERIALS AND METHODS

A total of 100 FNAC cases were studied by random sampling. Two smears were prepared for each case and stained by both, the MUFP and the rapid Pap stain. Scores were given and the quality index was calculated, followed by the statistical analysis. The number of cases was as follows: lymph node (43), thyroid (25), breast (23), salivary gland (02), and soft tissues (07). Scores were given on four parameters: Background of smears, overall staining pattern, cell morphology and nuclear staining. Quality index was calculated from the ratio of score achieved to the maximum score possible.

STATISTICAL ANALYSIS

Results were analyzed using Mean, Median, Standard Deviation, 't' paired test, 'P' value and M-diff for statistical significance.

RESULTS

Correct diagnosis was made in all cases. The quality index of MUFP smears was better compared to the rapid Pap stain in all the organs, and was statistically significant. MUFP smears showed a clear red blood cells background, transparent cytoplasm and crisp nuclear features.

CONCLUSION

MUFP is a reliable and rapid technique for cytology diagnosis.