Can PAP staining of air dried cervical scrape smears replace the traditional wet fixed smears?
MM Kamal1, S Dandige2, SM Kawthalkar3, HR Kulkarnil4, SN Parate1, CS Sarodey5, SK Bobhate6
1 Associate Professor, Department Of Pathology, Government Medical College, Nagpur, Maharashtra, India
2 Cytotechnologist, Department Of Pathology, Government Medical College, Nagpur, Maharashtra, India
3 Lecturer, Department Of Pathology, Government Medical College, Nagpur, Maharashtra, India
4 Lecturer, Department of PSM, Government Medical College, Nagpur, Maharashtra, India
5 Professor & Head, Department of Otolaryngology, Government Medical College, Nagpur, Maharashtra, India
6 Professor & Head, Department Of Pathology, Government Medical College, Nagpur, Maharashtra, India
M M Kamal
MA-8, Laxmi Nagar, Nagpur - 440 022, Maharashtra
Source of Support: None, Conflict of Interest: None
An alternative to ‘air drying’ artifacts seen in improperly wet fixed cervico-vaginal smears would be total elimination of fixation in alcohol and allowing the smears to dry in air. The primary objective of this study was to evaluate and compare the cell morphology in rehydrated air-dried smears (ADS) and the conventional wet fixed smears (WFS) and also to study the effect of postponing rehydration of smears. Three hundred and fifty cervical scrape smears were prepared from material collected from 10O patients. First smear from every patient (100) was wet fixed in 95% ethanol. The remaining smears (250) were air-dried and were divided in two groups. Group 1 included 100 ADS that were stained by Papanicolaou staining within three to four hours of collection. Group II included 150 ADS stained after 24 (50), 48 (50) and 72 (50) hours, to see the effect of postponing rehydration of ADS. Rehydration of ADS was done in normal saline for 20-30 seconds, followed by post fixation in 5% glacial acetic acid in 95% ethanol Using a scoring method the cytomorphology seen in ADS was compared with that of WFS for effect on background blood and mucus, nuclear chromatin, nucleolus, cytoplasmic details, overall ease of interpretation of the smear and degree of air drying artifact. The cytomorphology in ADS stained within 3-4 hours was comparable if not superior to that seen in WFS, as shown by the p values that were highly significant for inter-observer agreement and also comparable with the p values of WFS for all the parameters. In Group II cases the details of nuclear chromatin, nucleolus, differentiation of cytoplasm and restoration of its transparency were gradually and significantly lost with postponement of rehydration. However p value for overall ease of interpretation of cytomorphology was significant except for the smears rehydrated at 72 hours. Overall the smears showed no significant drying artifact even when rehydrated at 72 hours. Additional advantages like, reduction in the demand of alcohol and ease of preparing and transport of smears, can promote collection of Pap smears in more number of women especially in the rural areas.