Comparison of modified ultrafast Papanicolaou stain with the standard rapid 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.

The Shorr Versus Modified Ultrafast Papanicolaou Method for Intraoperative Diagnosis of Peritoneal Washing Cytology in Advanced Gastric Cancer: A Phase II Study

PURPOSE

According to the American Joint Committee on Cancer cancer staging system, positive peritoneal washing cytology (PWC) indicates stage IV gastric cancer. However, rapid intraoperative diagnosis of PWC has no established reliable method. This study evaluated and compared the diagnostic accuracy of the Shorr and the modified ultrafast Papanicolaou (MUFP) methods for intraoperative PWC.

MATERIALS AND METHODS

This study included patients with gastric cancer who were clinically diagnosed with stage cT3 or higher. The Shorr and MUFP methods were performed on all PWC specimens, and the results were compared with those of conventional Papanicolaou (PAP) staining with carcinoembryonic antigen immunohistochemistry. Sensitivity, specificity, and partial likelihood tests were used to compare the 2 methods.

RESULTS

Forty patients underwent intraoperative PWC between November 2019 and August 2021. The average time between specimen reception and slide preparation using Shorr and MUFP methods was 44.4±4.5 minutes, and the average time between specimen reception and pathologic diagnosis was 53.9±8.9 minutes. Eight patients (20.0%) had positive cytology in PAP staining. The Shorr method had a sensitivity of 75.0% and specificity of 93.8%; the MUFP method had 62.5% sensitivity and 100.0% specificity. The area under the curve was 0.844 for Shorr and 0.813 for MUFP. In comparing the C-indices of each method with overall survival, no difference was found among the Shorr, MUFP, and conventional PAP methods.

CONCLUSIONS

The Shorr and MUFP methods are acceptable for the intraoperative diagnosis of PWC in advanced gastric cancer.

Use of grape-based stain (Vinatela) on cervical cytology: A Peruvian validation study

Objectives

The Papanicolaou's (Pap's) stain is used for cervical cancer screening. It employs toxic-carcinogenic expensive reagents, which may not be easily accessible to many communities worldwide. The objective of this study was to validate the grape-based alcohol-extracted dye (Vinatela) on normal cervical samples for the Pap test.

Material and Methods

Samples of the two grape species were collected from two vineyards through the Agroindustrial Research Institute of Universidad Privada San Juan Bautista. The dye extraction from the grape species and the dye performance to stain cells were conducted in three phases: (a) direct staining with pre-fermentation wine products, (b) direct fragmentation of grapes and direct staining with shells of the grapes, and (c) alcoholic extraction of the dye. Vinatela obtained from two species (Vitis vinifera "Tempranillo" and "Malbec") and posterior staining of cervical samples. We conducted a double-blind validation on 30 cervical samples.

Results

The basophilic components of the cervical cells were stained. Alcoholic extraction staining protocol had a low yield. The nuclear and cytoplasmic borders, the nuclear details, and the polymorphonuclear nuclei were stained with Vinatela and could be differentiated during nuclear coloration. The initial staining protocol was 10- 20 min × (mean ~12 min) staining time. We noted a slightly better staining with V. v. Tempranillo as compared to V. v. Malbec (P = 0.045).

Conclusion

Cervical cells stained with Vinatela stain from two grape species cultivated in the Southern of Peru, showed basophilic nuclear details.

Rapid economical acetic acid Papanicolaou staining procedure versus conventional staining procedure in normal oral mucosa

Background

Papanicolaou (Pap) staining technique is a conventional technique used in cytology but it is time consuming.

Aim

The aim of the study was to determine the efficacy of Rapid Economical Acetic acid Papanicolaou stain (REAP) over conventional staining technique in studying normal oral mucosa.

Materials and Methods

Eighty patients were selected and were grouped based on their habits. Two smears were obtained from each patient and were subjected to both the staining techniques. A total of 160 slides were studied for features such as cellular outline, nuclear outline, nuclear details, cellular differentiation, micronuclei and cellular transparency.

Results

The conventional staining procedure showed 79 cases of optimal cellular staining, 78 cases of optimal nuclear staining, 35 cases of optimal nuclear details, 57 cases of optimal differentiation and 27 cases of optimal transparency and 33 cases of optimal micronuclei. REAP staining showed 75 cases of optimal cellular staining, 64 cases of optimal nuclear staining, 20 cases of optimal nuclear details, 36 cases of optimal differentiation and 28 cases of optimal transparency and 25 cases of optimal micronuclei.

Conclusion

REAP staining effectively reduces the time and the cost factor, but the cytological details are well observed under conventional staining technique in normal patients.

Rapid, Economic, Acetic Acid Papanicolaou Stain (REAP): An Economical, Rapid, and Appropriate Substitute to Conventional Pap Stain for Staining Cervical Smears

Background

The unanimous method of screening cervical cancer is a cervical smear stained with Papanicolaou stain. However, in spite of the various modifications, the staining procedure takes 20 min and uses substantial amount of alcohol which is highly priced. The aim of the study was to assess and analyze the quality of staining of cervical smears stained with Rapid Economical Acetic acid Papanicolaou (REAP) as compared to conventional pap stain in order to establish REAP as an alternative to conventional pap stain.

Methods and Material

In this prospective study, a total of two smears each were collected from 50 females who visited the gynecology outpatient department. One of the smears was stained with conventional pap and the other with REAP. The conventional pap and REAP smears were evaluated and compared for the quality of staining.

Results

The cervical smears stained with REAP showed optimal cytoplasmic and nuclear staining in 86% and 90% cases, respectively. The cytological findings and diagnosis of REAP stained smears correlated with their corresponding smears stained with conventional pap in 96% of cases. The turnaround time and cost per smear was much low for REAP as compared to conventional pap stain.

Conclusion

The present study was able to establish REAP as an appropriate alternative to conventional pap stain. The staining by REAP was comparable to conventional pap stain.

Human papillomavirus genotype profiles and cytological grades interlinkages in coinfection with HIV

Introduction

The study aimed to examine and characterize human papilloma virus (HPV) cytological grade trends and genotypes among HPV/HIV co-infected/cases and HPV monoinfected/control women attending Kisii Teaching and Referral Hospital, Kenya.

Methods

HIV positive co-infected with HPV (HPV/HIV) and HIV negative women monoinfected with HPV profiled as co-infected/cases and monoinfected/control arms respectively were enrolled. HPV subtypes were assayed by Xpert^® HPV system (GXHPV-CE-10) alongside pathological cytology analysis of cervical tissue samples.

Results

Low grade intraepithelial lesion (LSIL) was the most predominant cytological grade across cases and controls with a prevalence of 32 (38.1%) while high grade squamous intraepithelial lesion (HSIL) was highest among HPV/HIV co-infected with a prevalence of 23 (27.38%). Among the monoinfected (controls) the predominant lesion was low grade intraepithelial lesions (LSIL) with a prevalence of 23 (27.38%). HPV type 16 had the highest prevalence 26 (30.8%) among the VIA positive women in the overall study participants followed by combinations of HPV types (16, 18/45) at 19 (22.6%).

Conclusion

High risk HPV types 16 and 18/45 were the most predominant in the established cytological grades and among the co-infected women. Routine screening using both cytological and HPV testing should be embraced and/or reinforced as early screening and preventive strategies in the covered geographical region population. Provision of the currently available vaccines to these women at an early age would provide effective protection since the HPV type profiles in this population are covered by such vaccines.

Modified Ultrafast Papanicolaou Stain in Ultrasound Guided FNAC of Intra-abdominal Lesions

Background & Objective:

Modified Ultra-fast Papanicolaou (MUFP) stain has been developed from Papanicolaou stain (PAP) with the goal to improve staining quality, minimize staining time for obtaining immediate cytological diagnosis and to check specimen adequacy during Ultrasound guided Fine needle Aspiration Cytology (US guided FNAC). The aim of this research was to study the cytomorphological features of intra-abdominal lesions with help of US guided FNAC and to assess the diagnostic utility of Modified Ultrafast Papanicolaou stain in cytological diagnosis.

Methods:

This cross-sectional study enrolled consecutive 100 subjects in N.K.P Salve Institute of Medical Sciences and Research Centre, Nagpur, which is a tertiary teaching hospital in India, from July 2015 to June 2017 who underwent US guided FNAC for Intra-abdominal lesions. Fine needle aspiration was done under ultrasound guidance and the smears were divided into two groups. Wet smears were fixed in 95% ethyl alcohol for conventional PAP staining and air dried for MUFP. After staining, results were evaluated on basis of the cytological features. Scores were given according to four parameters namely background of smears, staining pattern, cell morphology and nuclear staining. Quality index was calculated from the ratio of score achieved to the possible maximum score.

Results:

The most common organs involved were ovaries (46 %) followed by liver (11%) and most common lesions were malignant (68 %). The cytological characteristic showed significant difference in all four parameters (P<0.05) when MUFP stain smears were compared with PAP stain smears. There was also statistically significant difference when cumulative score and Quality Index were compared (P<0.001) between the two stains.

Conclusion:

The US guided Fine needle aspiration (FNA) is simple, safe, rapid and inexpensive technique useful in cytological diagnosis. MUFP stain is fast, reliable and has better diagnostic utility for cytological diagnosis when compared to PAP stain.

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.

Usefulness of cytologic criteria in ultrasound-guided fine-needle aspirates from subcentimeter canine mammary tumors

We determined cytologic features of histologically confirmed subcentimeter canine mammary tumors (CMTs) to determine reasonable criteria for an accurate cytologic diagnosis. Fifty-three CMTs from 28 bitches were included. All cytologic samples were collected by ultrasound-guided fine-needle aspiration biopsy, stained with May-Grünwald/Giemsa, and retrospectively evaluated using a scoring system established for 18 cytologic features. Mean nuclear area (MNA) was also measured for each sample by a computer-assisted program. Based on the histologic diagnosis, CMTs were divided into 2 groups: malignant tumors (25) and benign lesions (15). Data were statistically analyzed using Fisher and Mann–Whitney tests. Chromatin pattern ( p < 0.05) and macrophage infiltration ( p < 0.05) were significantly different between the groups. Median MNA was significantly ( p < 0.05) larger in malignant tumors. The evaluation of these cytologic features in subcentimeter CMTs may increase the sensitivity of cytology.

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.

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.