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

Pancreatic cytomorphology based on Papanicolaou-stained smears has bee n studied extensively; however, studies on Diff-Quik-stained pancreati c 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 Dif f-Quik-stained pancreatic aspirates for intraoperntive consultations. All cases were reviewed and correlated with histopathology. In particu lar, three cases that proved to be adenocarcinoma on subsequent frozen section but were Mot so diagnosed during intraoperative fine needle a spiration evaluation were analyzed. The nuclear sizes of small tissue fragments with overlapping nuclei, including three cases of normal pan creatic 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 turne r (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 XBCs served as in ternal size controls. In Diff-Quik-stained, air-dried smears we relied on the accurate identification of pancreatic acini, which had the sam e size as the adjacent RBCs. Islet cell tumors had slightly larger nuc lei, which were much more variable in size. The nuclei of adenocarcino ma were much larger than the surrounding XBCs and also showed marked v ariation in size. The composition oi the pancreatic aspirate is import ant: ductal epithelium predominates in ductal carcinoma, and acini pre dominate in pancreatitis.