Comparison of Ultrafast Papanicolaou Stain with the Standard Papanicolaou Stain in Body Fluids and Fine Needle Aspiration Specimens

Abstract

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.

‘Ease of interpretation’ of cytological smears stained with modified ultrafast papanicolaou stain: Interobserver agreement and reproducibility

“…The colloid appeared pale and non‐descript than in other stains (Figure ). However in ‘scoring’ systems, the smears devoid of important background material would have been given a ‘better’/'clean’ score in rest of the studies . Similar to previous observations by Shinde et al, the omission of OG‐6 in UF‐PAP lead to poor visualisation of intracellular keratin in a metastatic squamous cell carcinoma, which led to the stain being rated as ‘worse’ by both pathologists in terms of cell morphology against all the routine stains (Figure ).…”

“…More so when it concerns the quality and preferred stains for relative ‘ease’ of interpretation. Many recent papers on the utility of MUFPAP stains in cytological laboratory have attempted to objectify the assessment of the MUFPAP stained smears by means of assigning ‘quality scores’ or ‘quality index’ and evaluation by the same or independent pathologists . Every assessed parameter (‘background, nuclear staining, cell morphology, and overall staining’) was given an arbitrary ‘score’ and the quality ‘index was calculated.…”

“…Studies by Alwahaibi and Yang et al have given slightly conflicting observations on the performance of UFPAP stains in fluid cytology. Alwahaibi et al observed that conventional pap stains to be better than UFPAP stain by comparing ‘quality scores’ while Yang inferred that UFPAP is the ‘preferred’ stain for non‐hematological fluids when compared to Diff‐Quik and CytoRich preparations. However, the staning procedures and reagents were widely different in both the studies.…”

“…The author reported promising results in his pilot study on breast aspirates and further on cytological smears from various organs . Since then, other authors have modified Kamal et al's modification, i.e., replacing Gill's Hematoxylin with Harris hematoxylin and these modifications have been tested on various cytological preparations …”

“…While the initial studies reported the features of the UF pap stain in a ‘descriptive’ fashion, various relatively ‘objective’ criteria including ‘diagnostic agreement’, ‘quality scores’, and ‘quality indices’ were introduced in studies published later on for comparisons with the other well‐standardized stains used in cytology . All these studies reported a superior performance of UF pap stain notwithstanding various modifications and settings.…”