Indian ink vs tissue marking dye: a quantitative comparison of two widely used macroscopical staining tool

Three dyes for use in tissue marking inks for biopsies and other small specimens

In histological processing, the loss of a small biopsies can prevent diagnosis by the pathologist. Appropriate specimen marking dyes are helpful, but those sold for the purpose have trade-secret components. The purpose of this study is to find suitable dyes with known chemistry to improve the visibility of small specimens. Samples of various organs, including stomach, lung, nasopharynx, small intestine and sentinel lymph nodes, were labeled with Rose red D-FR (CI 282855, Direct red 227), Blue 2RL (CI 24315, Direct blue 80), and Purple D-5BL (CI 29120, Direct violet 66). Clinical pathologists evaluated the dyeing capability and determined any interference of the marking dyes with diagnosis of stained sections. Direct red 227, Direct blue 80, and Direct violet 66 all increased the visibility of small specimens, without interfering with hematoxylin & eosin (HE) staining or immunohistochemistry. All three dyes can therefore be recommended for marking small specimens such as biopsies.

Targeted labeling with tissue marking dyes guided by magnifying endoscopy of endoscopic submucosal dissection specimen improves the accuracy of endoscopic and histopathological diagnosis of early gastric cancer: a before–after study

BACKGROUND

Although histopathological evaluation after endoscopic submucosal dissection (ESD) is critical to assess the accuracy of endoscopic diagnosis, it is still challenging to perform precise endoscopic to pathological evaluation. We evaluated the importance of tissue marking dye (TMD)-targeted marking for post-ESD specimen guided by magnificent endoscope on histopathological accuracy and endoscopic-to-histopathological reconstruction.

STUDY DESIGN

A total of 81 specimens resected by ESD [43 without TMD marking (N-TMD group), and 38 specimens with TMD-targeted cancerous areas marking guided by post-procedural magnifying endoscopy on resected specimens (TMD group)] between January 31, 2019, and January 31, 2022 at the Renmin Hospital of Wuhan University were included in the study. The baseline characteristics of patients, discrepancies between endoscopic and histopathological diagnosis, and the impact of TMD on histopathological diagnosis and reconstruction were analyzed.

RESULTS

Discrepancies between endoscopic (pre-ESD) and histopathological (post-ESD) diagnosis increased significantly in TMD group (68.4% (26/38) for tumor areas, 26.3% (10/38) for tumor margins, and 26.3% (10/38) for tumor differentiations) when compared with N-TMD group (p < 0.0001). Deeper sections were achieved in all TMD-marked resected lesions and 27.9% (12/43) lesions in the N-TMD group (p < 0.001). More pathological evaluations in TMD group were changed from curative resection to non-curative resection [6/38(15.8%) vs 1/43(2.3%)] compared with N-TMD group (p < 0.0001). TMD-targeted marking also improved the efficiency of histopathological reconstruction on pre-procedural endoscopic images and benefit endoscopists training.

CONCLUSION

TMD-targeted labeling on resected specimens could improve precise endoscopic-to-pathological diagnosis, reconstruction by point-to-point marking and benefit endoscopists training.

Anatomical description of the ventral and dorsal cervical rootlets in rats: A microsurgical study

Purpose:

To describe the anatomical aspects of the cervical rootlets and to quantify the number of rootlets that compose C1 to T1.

Methods:

Twenty male rats were used in this study. The dorsal rootlets from C1 to T1 were analyzed. To study the ventral rootlets, the posterior root avulsion was performed using a microhook, allowing exposure of the ventral roots through manipulation of the denticulate ligament and arachnoid mater. The parameters analyzed were the number of ventral and dorsal rootlets by side and level.

Results:

The formation of the respective spinal nerve was observed in the spinal roots the union of the ventral and dorsal roots. In four animals the C1 spinal root had no dorsal and/or ventral contribution. There is no normal pattern of numerical normality of the dorsal and ventral rootlets. The average number of fascicles per root was 4.08, with a slight superiority on the left side. There was a slight superiority of the dorsal rootlets compared to the ventral rootlets.

Conclusions:

This investigation was the first to study cervical rootlets in rats. In 20% of the sample studied, the dorsal root of C1 was absent mainly on the left side. There is a nonlinear numerical increase from C1 to T1 in the rootlets. There is a numerical predominance of cervical fascicles on the left side, confronting several studies related to the functional predominance of right laterality, requiring new studies that correlate these variables.

Utility of nail enamel for inking of surgical margins in oral biopsy: a comparative study

Background: India Ink is the most commonly used ink in surgical pathology. The main disadvantages of India Ink are longer drying time, monochrome, toxicity and cost. Because of these disadvantages, alternative materials have been suggested to replace India ink. The aim of this study is to evaluate the effectiveness of nail enamel for inking of surgical margin and to compare it with India ink. Materials and methods: N = 20, which included 10 mucosal and 10 skin samples. Each selected margin is divided into 2 equal halves and one is inked with India ink and the other with nail enamel (Vernis A Ongles: Dark green). After routine processing and staining, the effectiveness of nail enamel and India ink were compared based on macroscopic and microscopic parameters. Results: Less drying time and visibility on paraffin wax block were excellent for nail enamel. Microscopic visibility of nail enamel was comparable with that of India ink. However, processing fluids contamination is the main drawback of nail enamel. Conclusion: Nail enamel can be used as an alternative to India ink because of its less drying time, ease of application, good visibility on wax blocks and microscopically, availability in multiple colours, cost effectiveness and non-toxicity.

Alteration of Tissue Marking Dyes Depends on Used Chromogen during Immunohistochemistry

Pathological biopsy protocols require tissue marking dye (TMD) for orientation. In some cases (e.g., close margin), additional immunohistochemical analyses can be necessary. Therefore, the correlation between the applied TMD during macroscopy and the examined TMD during microscopy is crucial for the correct orientation, the residual tumour status and the subsequent therapeutic regime. In this context, our group observed colour changes during routine immunohistochemistry. Tissue specimens were marked with various TMD and processed by two different methods. TMD (blue, red, black, yellow and green) obtained from three different providers (A, B and C, and Whiteout/Tipp-Ex^®) were used. Immunohistochemistry was performed manually via stepwise omission of reagents to identify the colour changing mechanism. Blue colour from provider A changed during immunohistochemistry into black, when 3,3′-Diaminobenzidine-tetrahydrochloride-dihydrate (DAB) and H₂O₂ was applied as an immunoperoxidase-based terminal colour signal. No other applied reagents, nor tissue texture or processing showed any influence on the colour. The remaining colours from provider A and the other colours did not show any changes during immunohistochemistry. Our results demonstrate an interesting and important pitfall in routine immunohistochemistry-based diagnostics that pathologists should be aware of. Furthermore, the chemical rationale behind the observed misleading colour change is discussed.

Inking of gross specimens: a systematic review

BACKGROUND AND AIM

Histopathological Evaluation of surgical margins of a resected tumour specimen can give an insight about the extent of tumour spread. Errors in proper identification and orientation of resected tumour margins can lead to treatment failure and poor prognosis. Inking of resected margins is the most reliable and safe method. The aim of this study is to systematically review the studies which compares various materials used for inking of surgically resected specimen.

MATERIALS AND METHODS

Articles searched from PubMed, Cochrane, Google search, manual search using key words - inking, tissue marking dyes, surgical margin, tumour margin, surgical pathology, grossing, gross specimens and back references of the articles, yielded three articles. Three articles with a total sample size of 1325 and compares properties of India ink, Acrylic colours and Tissue Marking Dyes were considered in this review.

RESULTS

Both India ink and acrylic colours are good with respect to the Ease of application, visibility on paraffin wax blocks, Visibility on naked eye examination of slides and Visibility on microscope. Acrylic colours have less drying time than India ink. India ink do not result in contamination of tissue processing fluids, Interference with cellular and nuclear details and penetration in to tissues when compared with acrylic colours.

CONCLUSION

India Ink will continue to dominate as the best surgical ink when comparing all the parameters till newer studies are available for acrylic colours or other dyes. Acrylic colours have the potential to be widely used as a tissue marking dyes except for the few disadvantages.

Analysis and Comparison of Tissue-Marking Dye Detection via Light Microscopy, Telemicroscopy, and Virtual Microscopy

Objectives

To examine the fidelity of ink color identification using light microscopy (LM), telemicroscopy (TM), and virtual microscopy (VM).

Methods

Twenty H&E-stained frozen section slides, prepared after tissue inking with five stain combinations, were assessed by three pathologists using LM, TM, and VM. TM was performed using Mikroscan D2 slide scanner/LiveQ software with various objectives. VM was performed using Mikroscan D2 scanner/Qumulus software, specimens digitized at20×.

Results

Sensitivity/specificity by LM was 100%/100% for all colors. TM showed high overall specificity but poor sensitivity, particularly red (54%). VM showed high specificity for all colors except black (69%) and, consequently, poor sensitivity for all colors except black (96%).

Conclusions

TMD identification via telepathology showed loss of sensitivity/specificity vs LM and highlighted the need for caution when interpreting TMDs with digital technologies and the need for validation protocols.

Comparative Study of Acrylic Color and India Ink for Their Use as a Surgical Margin Inks in Oral Squamous Cell Carcinoma

Objective

To compare acrylic color and India ink for their use as a surgical margin. Since, acrylic paints are available in multiple colors, they can be used to mark different surgical margins with different specific colors.

Materials and methods

The study was carried out on 30 surgically excised and formalin fixed oral squamous cell carcinoma (OSCC) specimens. Four surgical margins of each 15 specimens were marked with India ink and the remaining were marked with acrylic colors. The grossed specimens were then processed using routine histopathology technique. The 4 mm sections of tissue block were cut using microtome and sections were stained with hematoxylin and eosin stain. Various macroscopic and microscopic parameters were used to study the suitability of acrylic color as surgical ink.

Results

Three different technicians found equal ease of application for acrylic color and India ink. The drying time for acrylic color (1.30 ± 0.009 minutes) was significantly less than India ink (2.30 ± 0.05 minutes). Out of total 60 blocks made for acrylic colors, 52 (86.66%) displayed clear visibility on paraffin blocks (93.33%). In contrast, out of 60 blocks made for India ink, only 34 showed faint visibility on paraffin blocks (56.66%). All acrylic colors were visible very clearly and uninterruptedly under the microscope, while three (5%) surgical margins stained with India ink were interrupted. With the acrylic colors, no contamination or staining of other tissues, processing fluids and solutions were reported. However, with India ink, three (5%) samples reported contamination in alcohol and xylene. There was no interference with the microscopic interpretation of nuclear and cellular details for both acrylic color and India ink whatsoever.

Conclusion

Acrylic colors are more suitable as surgical ink over India ink because of its availability in different colors, ease of application, faster drying time, and no contamination with processing fluids, easy availability and excellent visibility on paraffin blocks and under microscope. Moreover, if needed, painting with multiple colors could also help in reassessment of surgical margins of the gross specimen in the future.

How to cite this article

Sarode SC, Sarode GS, Patil S, Mahajan P, Anand R, Patil A. Comparative Study of Acrylic Color and India Ink for Their Use as a Surgical Margin Inks in Oral Squamous Cell Carcinoma. World J Dent 2015;6(1):26-30.

Variable fidelity of tissue-marking dyes in surgical pathology

AIMS

Pathology specimens often contain important margins that must be identified from gross examination of specimens through to microscopic examination. Commonly, unique colours of tissue-marking dye (TMD) are applied to each margin, which facilitates both macroscopic and microscopic identification. Various techniques have been described, but the colour endurance and fidelity of TMDs following special tissue processing have not been addressed. The aim of this study was to evaluate the performance of various TMDs through decalcification and immunohistochemistry (IHC) protocols.

METHODS AND RESULTS

Samples of TMDs from two manufacturers and acrylic artists' inks were obtained in seven colours and applied to excess non-diagnostic surgical pathology tissue. Tissues were subjected to a decalcification protocol or directly processed in a routine fashion. The presence and colour of TMD or ink were assessed on routine H&E sections and following IHC. Of the colours that reliably survived routine processing, loss of colour and colour change following decalcification and IHC protocols were seen with one manufacturer's product.

CONCLUSIONS

TMD may lose or change its colour during special tissue processing. This previously unreported artefact may lead to potentially serious errors in margin assessment and reporting. Laboratories should evaluate TMDs and inks through routine processing, decalcification, and IHC protocols, to ensure colour endurance and fidelity.