Prospective comparison of cytological specimen adequacy assessment by different rapid staining techniques for rapid on‐site evaluation in fine needle aspiration cytology and their cost‐effectiveness

Abstract

Objective Rapid on‐site evaluation (ROSE) is a technique beneficial in determining the adequacy of the samples, thereby increasing the diagnostic yield, useful in triage of specimens for ancillary studies and can also help determine a preliminary diagnosis in emergency cases. The different rapid stains for on‐site evaluation described in the literature are diff quik, toluidine blue (TB), brilliant cresyl blue (BCB), ultra‐fast Pap stains, and rapid hematoxylin and eosin (H&E). This study was undertaken as there is sparse literature regarding the best and the most cost‐effective rapid stain. Method Fine needle aspiration samples from 200 patients with palpable swellings in easily accessible regions were taken. Smears stained by rapid and routine stains were assessed based on four parameters, with provisional diagnosis on the rapid stained smears. A comparative analysis of the advantages and disadvantages of the rapid stains was carried out with appropriate statistical tests with the routinely stained smears as gold standard. Results There was adequate material in 100% of ROSE smears. rapid pap stained smears showed well preserved cytoplasmic details, nuclear details, and background details. The time taken was least with TB and BCB being 5 s each. The most cost‐effective was found to be TB. Conclusions We conclude that TB is the most cost‐effective, quick, least labor‐intensive, and reliable rapid stain for ROSE especially in resource‐poor settings.

Improving ROSE: Discrepant touch preparation and histology findings in cytology of renal masses: A 10‐year retrospective review

“…The touch preparation slides are then either air-dried and stained with Diff-Quik stain per standard protocols or ethanol-fixed and stained with rapid Pap stain per standard protocols. From our study, there was a higher proportion of rapid Pap-stained slides that were interpreted as non-diagnostic due to hypocellularity as compared to Diff-Quik stained slides, possibly related to the differences in stain preparation, although these results are in contrast with other studies in the literature in which rapid Pap stain was found to have superior yield and accuracy 21,22. At our facility, more cytopathologists prefer to utilize the rapid Pap stain.…”

Ultrafast Toluidine Blue Staining for Rapid On-Site Evaluation of Cytological Smears

“…Finally, depending on each laboratory's practice, cytopathologists may prefer alcohol-fixed over air-dried slides. Conversely, the time required is longer than the nominally 5 s (without air-drying and fixation, respectively) reported for brilliant cresyl blue or a specific modification of toluidine blue [3], but in contrast to these our protocol does not compromise on staining quality. This is particularly important when -as in the case of our interdisciplinary thyroid FNA unit -not only specimen adequacy is assessed but also provisional diagnoses are communicated or triage for ancillary testing is required.…”

“…Common stains include modifications of the Romanowsky-type stains (Diff-Quik etc. ), Papanicolaou or Hematoxylin-Eosin stains, and brilliant cresyl blue [3]. From a practical point of view, the number and type of staining components and solvents required are additional factors influencing the feasibility of a particular protocol, given that all must be transported from the cytopathology laboratory to the site of assessment and back.…”

Usefulness of rapid on-site evaluation specimens from endoscopic ultrasound-guided fine-needle aspiration for cancer gene panel testing: A retrospective study

“…ROSE specimens used in this study had three features. First, ROSE specimens at our institution were created by rapid hematoxylin and eosin staining, which has been reported to provide almost the same findings as rapid Papanicolaou staining [23] and has been reported not to affect DNA analysis [24]. Second, ROSE specimens at our institution were evaluated by a cytotechnologist to assess sample adequacy.…”