Individual specimen triage of effusion samples: An improvement in the standard of practice, or a waste of resources?

The standard of practice in cytopathology does not include an individual sp ecimen triage (IST) for sample optimization, but rather prescribes a unifor m procedure, e.g., for smears, cell blocks, and cytospins. IST requires add itional resources. We sought to evaluate whether IST would result in enhanc ed diagnostic accuracy and specimen turnaround time in effusions. In order to evaluate the efficacy of IST, 50 effusion samples (31 pleural, 16 perito neal, and 3 pericardial), each with a minimum volume of 50 ml, were utilize d. Each sample was prepared via IST to include at least two initial prepare d Diff-Quik-stained cytospins on which the IST was based as well as a stand ard cytopreparation protocol for nontriaged samples (NTS) which was limited to 3 smears (2 Papanicolaou-stained, and 1 Diff-Quik-stained) and a hemato xylin-eosin (H&E)-stained cell block section. All triaged and NTS were revi ewed retrospectively to determine if IST offered any advantages over the st andard cytopreparation protocol for effusion samples Each was evaluated for diagnostic concordance, turnaround time for final diagnosis, and optimal p reparation In 46 cases, diagnoses in IST and NTS were 100% concordant. Four cases showed minor discrepancies between the original and rite NTS diagnos es. In general, the discordant cases were due to sparse cellularity in a sp ecimen composed largely of blood. There was no difference in turnaround tim e for final diagnosis. Based on a review, of all samples, the combination o f cell block preparation and cytospins (stained with Diff-Quik and Papanico laou stains) were considered optimal for microscopic evaluation. IST offers no practical advantage over the NTS standard specimen preparation in relat ion to the accuracy of final diagnosis or turnaround time. The lysing of gr ossly bloody fluids with subsequent preparation of cytospins yielded superi or preparations for microscopic evaluation over NTS The standard preparatio n of effusion samples should include the preparation of a cell block, and c ytospins stained with Diff-Quik and Papanicolaou stains for optimal microsc opic evaluation. Diagn. Cytopathol. 2000,22:7-10. (C) 2000 Wiley-Liss, Inc.