Application of Ultrafast Papanicolaou stain to body fluid cytology.

OBJECTIVE: To investigate the applicability of the Ultrafast Papanicolaou stain to the cytology of fluids and to compare it with other methods. STUDY DESIGN: Over a 30-month period, 528 unfixed fluids (462 serous effusions, 48 pelvic washings, 16 cyst fluids and 2 bile duct drain fluids) were mixed thoroughly and centrifuged. Two Swedish-style air-dried smears were made and stained with Diff-Quik (Mercedes Medical, Inc., Sarasota, Florida, U.S.A.) and Ultrafast Papanicolaou stain (Richard Allan Scientific, Kalamazoo, Michigan, U.S.A.), and the remaining sediment was fixed in CytoRich Red (TriPath Imaging, Inc., Burlington, North Carolina, U.S.A.), centrifuged onto a 17.5-mm circle with a Hettich cytocentrifuge and stained by the Papanicolaou method. RESULTS: For the 115 malignant fluids, Ultrafast Papanicolaou stain was the preferred method in the 94 non-hematopoietic malignant fluids, Diff-Quik was the preferred method in the 9 hematopoietic malignancies, and CytoRich Red was the preferred preparation in 8 bloody effusions containing rare cancer cells and 4 malignant pelvic washings. The diagnostic turnaround time of smears stained by Ultrafast Papanicolaou stain was < 15 minutes, fast enough for intraoperative consultations. CONCLUSION: It seems that Ultrafast Papanicolaou stain improves the resolution of cytoplasmic and nuclear details of nonhematopoietic cells in body fluids. However, to detect cancer in all types of fluids, Diff-Quik and CytoRich preparations are also required. We now examine three slides per fluid sample, one slide by each of the three techniques.

Compact cell blocks. Use for body fluids, fine needle aspirations and endometrial brush biopsies.

OBJECTIVE: To obtain an ideal cell block wherein the maximal number of cells are displayed within the smallest area on the block surface. STUDY DESIGN: Cyto-Rich Red (AutoCyte, Inc., Elon College, North Carolina, U.S.A.) is added to fresh cellular sediment in a centrifuge tube at a ratio of 1:1. After two minutes, three to four drops of plasma and topical thrombin (5,000 U/10 mL) is added. The tube is then gently agitated for two minutes, until a gelatinous clot is obtained. The clot is then slid onto a lens tissue on top of paper towels. The lens tissue is folded once over the clot. By gently squeezing the excess fluid from it through the lens tissue into the paper towels, the clot is transformed into a flat, compact, densely cellular aggregate, which is painted with mercurochrome prior to fixation in formaldehyde. RESULTS: From each of the 495 cases, including 250 body cavity fluids, 170 fine needle aspirates and 75 endometrial brush biopsies, processed with the above protocol, there was a compact cell block containing packed cells or tissue fragments in a clean background devoid of red blood cells. CONCLUSION: The compact cell block is about 10-20% the size of a conventional cell block, yet more cells are on display, thus reducing the need for deeper cuts and screening time while increasing the efficiency of cytodiagnosis. The compact cell block technique is particularly helpful for endometrial brush biopsies.

Comparison of PCR and standard cytological staining for detection of Pneumocystis carinii from respiratory specimens from patients with or at high risk for infection by human immunodeficiency virus.

The detection of Pneumocystis carinii DNA by PCR was compared with routine cytologic staining techniques (CYT). A total of 284 clinical respiratory specimens, including 137 bronchoalveolar lavage (BAL), 63 bronchoalveolar washing, 63 sputum, and 21 induced sputum samples, obtained from patients with or at high risk for human immunodeficiency virus infection were evaluated. Eighty specimens were positive by PCR, and 69 were positive by CYT. PCR was able to detect P. carinii in more bronchoalveolar washing specimens (15 versus 11) and in comparable BAL specimens (53 versus 54) compared with CYT. PCR was particularly more sensitive than CYT in detecting P. carinii in expectorated sputum (12 versus 4 samples). Of the 19 patients whose respiratory specimens were positive for P. carinii by PCR but negative by CYT, 5 had P. carinii pneumonia (PCP) confirmed by subsequent BAL and transbronchial or mediastinal lymph node biopsy and 9 had a clinical course highly suggestive of acute PCP. Eleven (58%) of the 19 patients with discordant PCR and CYT results had received prior anti-PCP prophylaxis. In this clinical setting in particular and in the evaluation of sputum specimens, the ability of PCR to detect a low parasitic load suggests that this technique may become an important additional tool, along with current cytological methods, for the detection of P. carinii.