Diagnostic utility of touch imprint cytology for intraoperative assessment of surgical margins and sentinel lymph nodes in oral squamous cell carcinoma patients using four different cytological stains.

BACKGROUND: OSCC is most commonly associated with positive surgical margins. The important cause of loco regional recurrence is histologically positive or closed margins. Clear surgical margins might favor the patient with a better prognosis and prevent repetitive surgeries. The present study was designed to the diagnostic utility of touch imprint (TI) smears using H and E, Pap, Giemsa and Feulgen stains, so that they can be used on a routine basis. MATERIALS AND METHODS: A total of 720 smears from 130 margins resected from 32 patients who underwent surgical resection of OSCC were prospectively evaluated. The slides were fixed in alcohol and randomly divided into four different batches for staining with H&E, rapid Pap, Giemsa, Feulgen stain. TI of 30 sentinel lymph node were fixed in 95% alcohol, stained by (H&E) and evaluated by two independent observers. The results were compared with gold standard histopathology. RESULTS: H&E stain showed sensitivity 44%, rapid Pap 35%, Giemsa 29% and Feulgen stain 25%. Positive predictive value-100% for all the four stains. NPV-H&E 70%, Pap 66%, Giemsa 62%, Feulgen 59%. Diagnostic test accuracy of H&E stained smears was higher 72%, compared to Pap 67%. Giemsa 65%, and Feulgen 63%. In lymph nodes, Specificity was 94.74%, PPV 90.91%, NPV 94.74%, diagnostic accuracy 93.33%. CONCLUSION: TIC is effective in identifying an inadequate or severe dysplasia margin comparable to gold standard histopathology. It might be used to intraoperatively identify metastases in sentinel lymph nodes in clinically N0 Patients.

Spritzer: For diagnostic cytopathology.

BACKGROUND: Exfoliative cytology is an easy, economical, noninvasive, and feasible method for early detection and screening program of any premalignant or malignant lesion. In case of routine cytological procedure, classical Papanicolaou (PAP) stain is widely used while Romanowsky stains are sparingly used. Leishman-Giemsa (LG) cocktail, being a easier, cost effective staining technique, has not been used in exfoliative cytology. Therefore, this pilot study was carried out to compare and contrast the role of LG stain in routine cytological procedure which is very cost-effective, less time-consuming and requires less infrastructural support. AIM AND OBJECTIVES: To study the diagnostic efficiency of LG cocktail in comparison with PAP stain and Feulgen stain in mucosal cells for evaluating cellular changes of oral squamous cell carcinoma (OSCC). MATERIALS AND METHODS: Three cytological smears were prepared from 10 healthy controls and 10 patients clinically diagnosed with OSCC, and they were stained with LG cocktail stain, PAP stain, and Feulgen stain. The stained smears were evaluated for cytologic diagnosis and the staining characteristics such as nuclear and cytoplasmic details were recorded as per criteria by Sujathan et al. STATISTICAL ANALYSIS: The data were statistically evaluated with analysis of variance test using SPSS 15 software for windows. RESULTS: The results from the cases diagnosed as OSCC by PAP and LG cocktail were almost identical and superior to Feulgen stain both in diagnostic ability and in staining characteristics. CONCLUSION: The one-step LG cocktail is easy, very cost-effective, less time-consuming with less infrastructural support as compared to PAP stain; however, it warrants further evaluation for screening of oral cancer as a potential aid.

Use of telecytology for the immediate assessment of CT guided and endoscopic FNA cytology: diagnostic accuracy, advantages, and pitfalls.

Telecytology (TC) can assist cytopathologists in efficiently providing immediate evaluation for fine needle aspirations (FNAs) performed at remote locations. Our aim was to evaluate the accuracy and feasibility of TC for immediate assessments of FNAs. Phase I: Diff-Quik and Pap stained smears from two retrospective sets of 20 pilot cases each (n = 40) were included for TC assessments. For the first set, diagnoses were rendered by four pathologists and for the second set, in addition, four cytotechnologists also participated. Diagnostic concordance with the final diagnosis was assessed. Phase IIA: These were followed by real time assessments (RTA) of 56 TC FNAs and diagnostic concordance was compared to that of 100 conventional in-person immediate assessments (Phase IIB). Phase I: 79/80 (98.8%) diagnoses (20 cases × 4 pathologists) from the first set were accurate. On the second set, 160 diagnoses were rendered on Pap stained slides and 160 on Diff-Quik stained slides. The accuracy rate was 95% (76/80) for malignant diagnoses and 96.2% (77/80) for benign diagnoses on Pap stain. Diff-Quik stains were more difficult to interpret than Pap stains and accuracy rates for them were lower. Endoscopic bronchial ultrasound guided (EBUS) FNAs of paratracheal nodes were more difficult to interpret. Phase IIA and B: 95% (53/56) RTAs by TC were concordant with the final diagnoses compared with 97% (97/100) for in-person assessments. TC is a useful aid and yields concordance rates comparable to in-person assessments. Individual practices should perform pilot studies to understand the pitfalls and limitations before employing telecytology.

Fine needle aspiration of parathyroid lesions.

OBJECTIVE: To assess the cytologic features of parathyroid lesions and to determine if it is possible to differentiate between parathyroid hyperplasia (PH) and parathyroid adenoma (PA) based on fine needle aspiration (FNA). STUDY DESIGN: FNAs of 14 parathyroid lesions were performed during intraoperative consultation. Alcohol-fixed, Papanicolaou-stained smears and air-dried Diff-Quik-stained smears were prepared in each case. Cytologic features were evaluated. RESULTS: All cases, PA and PH, showed numerous bare nuclei in the background. Ninety percent of PA contained microfollicular groups in addition to sheets and syncytia, while PH was arranged primarily in sheets and syncytia without microfollicles. Nuclear pleomorphism was seen in 33% of PA and absent from PH. CONCLUSION: Careful evaluation of cytologic features might help to differentiate between PA and PH on FNA.

Morphometry and quality control for a May-Grunwald Giemsa stained preparation. A 40 centers cooperative study.

A multicentric study including 40 medical centers has been done on May-Grunwald Giemsa (MGG) stain, to obtain precise information concerning the size, shape and color of cellular elements. A number of factors are taken into consideration including the zone of microscopic observation, the quality of staining, condition of grabbing images and the size of the sample. Morphometric and colorimetric measurements have been applied as objective tools for demonstrating the predominance of each Red/Green/Blue component, and more particularly their reciprocal ratio. The results obtained for each center may constitute a guideline for adjusting their procedure, in order to reach a consensus regarding similar staining by all centers.

Histologic assessment of Helicobacter pylori status after therapy: comparison of Giemsa, Diff-Quik, and Genta stains.

To compare the Giemsa, Diff-Quik, and Genta stains for detection of Helicobacter pylori in gastric biopsy specimens, we stained, coded, and randomized slides, which were then independently reviewed by two pathologists and one trainee. H. pylori was graded from 0 (absent) to 5 (maximal intensity). Negative cases were from recently cured patients to ensure that a background of chronic inflammation was present. The time required to complete the evaluation was tabulated. The pathologists interpreted 72 H. pylori-negative slides, of which 1 (1.3%), 2 (3%), and 3 (4%) were scored positive (each with the score of 1) with Diff-Quik, Genta, and Giemsa stains, respectively (P = ns). Of the 128 H. pylori-positive slides, 5 (4%) had false-negative results with Diff-Quik, 8 with Genta (6%), and 14 with Giemsa stains( 11%). No Grade 2 slides were missed by Genta or Diff-Quik stains, but 3 of 20 were missed by Giemsa stain. The combination of hematoxylin and eosin and Diff-Quik provides accuracy similar to that of the Genta stain but requires more processing time. No stain was excellent after therapy for detecting one or two bacteria per slide; this finding emphasizes the need for obtaining multiple biopsy specimen to exclude failure of H. pylori therapy.