title: Rapid assessment of Diff-Quik-stained pancreatic aspirates. A retrospective study of 40 intraoperative fine needle aspiration consultations, with measurement of nuclear size of look-alike small tissue fragments by image analysis.
abstract: Pancreatic cytomorphology based on Papanicolaou-stained smears has been studied extensively; however, studies on Diff-Quik-stained pancreatic smears are rather limited. Air-dried, Diff-Quik-stained smears lack crisp nuclear details, the cells are flattened on the slides, and the nuclei appear large and hyperchromatic. Between January 1988 and June 1992, 40 cases of intraoperative pancreatic fine needle aspirates were assessed by Diff-Quik stain. The objective of this study was to find practical clues applicable to the rapid and accurate assessment of Diff-Quik-stained pancreatic aspirates for intraoperative consultations. All cases were reviewed and correlated with histopathology. In particular, three cases that proved to be adenocarcinoma on subsequent frozen section but were not so diagnosed during intraoperative fine needle aspiration evaluation were analyzed. The nuclear sizes of small tissue fragments with overlapping nuclei, including three cases of normal pancreatic acini (mean diameter, 0.98, 1.17 and 1.04 x RBCs; coefficient of variation, 0.53, 0.83 and 0.62 x RBCs), 2 cases of islet cell tumor (mean diameter, 1.19 and 1.32 x RBCs; coefficient of variation, 1.88 and 1.4 x RBCs) and 3 cases of adenocarcinoma (mean diameter, 1.55, 1.86 and 1.72 x RBCs; coefficient of variation, 1.5, 1.7 and 1.9 x RBCs) were obtained with an image analyzer. The adjacent RBCs served as internal size controls. In Diff-Quik-stained, air-dried smears we relied on the accurate identification of pancreatic acini, which had the same size as the adjacent RBCs. Islet cell tumors had slightly larger nuclei, which were much more variable in size. The nuclei of adenocarcinoma were much larger than the surrounding RBCs and also showed marked variation in size. The composition of the pancreatic aspirate is important: ductal epithelium predominates in ductal carcinoma, and acini predominate in pancreatitis.
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Pennsylvania Medical Center, Philadelphia.
authors.forename: G C
authors.initials: GC
authors.lastname: Yang
authors.forename: S
authors.initials: S
authors.lastname: Slott
authors.forename: V A
authors.initials: VA
authors.lastname: LiVolsi
authors.forename: P K
authors.initials: PK
authors.lastname: Gupta
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002467:Cell Nucleus / Q000648:ultrastructure; D003581:Cytodiagnosis / Q000379:methods; D005260:Female; D006801:Humans; D007432:Intraoperative Period; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000473:pathology*; D010190:Pancreatic Neoplasms / Q000473:pathology* / Q000648:ultrastructure; D012189:Retrospective Studies; D013194:Staining and Labeling