Riu's stain, a Romanowsky‐type stain, has been in use in Taiwan over the past 40 years. In order to determine whether it is useful for the diagnosis of thyroid disease in thyroid fine‐needle aspiration, we reviewed 254 of these aspirates obtained between April 1990 and June 1996 from patients seen in Koo Foundation Sun Yat‐Sen Cancer Center in Taipei. Surgical follow‐up was available for confirmation in 61 aspirations. The cytologic diagnosis was categorized into four groups: benign, 174; suspicious, 30; malignant, 41; and inadequate specimen, 9. There were two false‐negative and no false‐positive diagnoses. Our results showed a sensitivity of 93.5% and a specificity of 100% for the detection of malignancy. If suspicious cases were considered positive, the specificity decreased to 55%, while the sensitivity increased to 95%. We conclude that Riu's stain is a reliable quick stain in the diagnosis of thyroid malignancy. Compared to Papanicolaou stain, it shortens the time needed for a cytopathologist to reach a diagnosis. Papanicolaou stain can be reserved for confirmation. Diagn. Cytopathol. 16:543–547, 1997. © 1997 Wiley‐Liss, Inc.

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Key Words: Riu's stain; fine-needle aspiration; thyroid gland; sensitivity; specificity Riu's stain 1 is a Romanowsky-type stain which was first described in Taiwan in 1953 and became widely used here by hematology laboratories. It is a stain of comparable quality to Wright-Giemsa but is a much faster stain which takes only 2 minutes to complete a two-step procedure. The details of the stain have recently been elaborated. 2 Our Department is one of the progressive surgical pathology departments in the Far East that use Riu's stain routinely on fine-needle aspiration (FNA) specimens. Herein we review our experience on thyroid FNAs over a 6-yr period with special emphasis on the diagnostic usefulness of Riu's stain. Materials and MethodsBetween April 1990 and June 1996, 254 thyroid FNAs from 218 patients were performed at Koo Foundation Sun YatSen Cancer Center. The aspirates were procured by clinicians either by palpation or under ultrasonography guide to locate the lesion for aspiration with a 23-or 25-gauge needle. Alcohol-fixed and air-dried smears were both obtained. The air-dried smears were immediately stained by Riu's method. The alcohol-fixed smears were stained by Papanicolaou stain in batches later in the afternoon on the same day or on the following day. Cytospin preparations were also made in situations where fluid was aspirated.The cytologic results were reported immediately after the Riu-stained slides were reviewed. The Papanicolaou-stained slides were later reviewed for confirmation. The results were categorized into four groups: benign, suspicious for malignancy, positive for malignancy, and inadequate specimen. Benign category encompassed goiter (colloid cyst, nodular hyperplasia) and thyroiditis. The suspicious for malignancy category including inconclusive cases encompassed follicular neoplasm and the aspirates that did not fulfill strict criteria for papillary carcinoma. The adenomatous goiters were also placed in this category because of the difficulty in separating it from follicular neoplasm. The positive for malignancy category encompassed either primary or metastatic malignancies. The adequacy of the specimen and the cytologic diagnosis of all primary thyroid malignancies were based on Kini's criteria. 3 Surgical pathology sections were available in 61 cases. The cytologic interpretations were confirmed by and correlated with the histologic findings. Sensitivity, specificity, positive predictive, and negative predictive value were determined using the methods of Galen and Gambino. 4 Results Table I summarizes the results of the 254 aspirates obtained during a 6-yr period. The 218 patients (38 male/180 female) ranged in age from 22 to 94 yr. Surgical follow-up was available in 61 patients. Cytological and surgical findings are compared in Table II.

The immune responses of developing opossoms were studied after one or two injections of bacteriophage f2. Antibodies could be detected in serum of developing opossums as early as 7 days after immunization and peak antibody responses were reached 14 or more days after immunization. A second injection of antigen usually increased the level of serum antibodies only slightly. The antibodies of these embryos were further studied by sucrose density gradient centrifugation. The earliest antibodies appeared as 13S “embryonic” antibodies localized between 19 and 7S positions in the sucrose density gradients. IgM antibodies appeared later as the embryonic antibodies decreased. IgG antibodies were never prominent and were the last to appear in measurable amounts during development.

The endoscopic appearance of gastrointestinal metastasis from breast cancer is demonstrated in this report. A patient with breast cancer was found by panendoscopic examination to have duodenal metastases. The endoscopic characteristic was that of multiple urnbilicated submucosal tumors in the bulb and second portion of the duodenum. The imprint cytology of duodenal biopsy specimens, which revealed malignant cells identical to those found in the breast lump aspiration previously, supported the initial endoscopic diagnosis of metastatic breast cancer. The histology of these lesions subsequently revealed many tumor emboli in the mucosal and submucosal lymphatic channels. A laparotomy conducted to perform an intestinal bypass disclosed a large fixed metastatic tumor in the upper retroperitoneum with extension to the mesentery, the mesocolon of the transverse colon and the third portion of the duodenum. The findings at laparotomy and the histologic evidence of tumor emboli in the lymphatics of the mucosal and submucosal layers indicated a retrograde lymphatic spread of the tumor from the large retroperitoneal mass to the duodenal wall. A literature review in this report discusses the differential diagnosis from metastatic disease to second primary malignancy and benign disease of the gastrointestinal system. (Dig Endosc 1994 ; 6 : 281-286)