From what I have learned and the interactions I had with our pathologist friend in China, I would like to bring this topic to discuss: What are the stains you routinely used for FNA cytology? H&E or Diff-Quick or Pap or any 2 of the above 3?

What are the advantages and disadvantages of each of the stains?

 Great!

It seems that colloid is less sticky than mucin, and they show different color in Diff-Quick stain.

Thank you for the comments Urbino! I now posting some pictures of diff-quick for illustration:

Picture 1: you can see the nice thick colloid with cracking artifacts, it is typical of colloid nodule.

Picture 2: shows the typical chondroid-myxoid stroma of pleomorphic adenoma

Picture 3: a case of breast colloid carcinoma, you can see the "balls" of tumor cells, the Diff-Quick stain also highlights the background mucin.

 Yes,  toludine blue is 亚甲蓝. I know one of the adventage of  toludine blue stain is the color can be washed off by put the slide into 95% alcohol, allow the slide is stained again by other dye.

I appreciate Dr. Chen's coment very much, especially the diff-quick part. To evaluate the background of the smear, such as colliod, mucus etc, is my weakness. Can you talk more about it. It will be better to put some pictures together. 

Thank you very much!

 Is 亚甲蓝 toludine blue? Actually I had a chance to visit and learn FNA cytology at the University of California at San Francisco, their pathologists perform more than 3000 FNAs a year in their own FNA clinic. They used toludine blue for their rapid review and Pap stain for their permanent stain. I liked it a lot.

 Let's further discuss the stain options we have. The reason that most of the cytopathologists in the US don't like the rapid H&E is that the stain introduces artifacts. For example, in thyroid FNA (very common specimen), it produces pseudo "hole" in the nucleus, which can lead the pathologist to over-diagnose papillary carcinoma. Also, it dissolves the colloid, which can lead the pathologist to over diagnose follicular neoplasm. One of the cases recently posted here by LjmLjm used H&E, although I don't see much colloid on the picture, the follicular cells are pretty much in flat sheet. some people immediately jump into "follicular neoplasm". It is true that Pap stain will dissolve colloid too, but Pap stain shows excellent nuclear cytomorphology and it is very close to H&E in term of cell size (for most of us doing both cytology and surgical pathology, it is helpful). Although not showing as clear a cytomorphology as Pap stain, the diff-quick (or it's variant) stain tends to preserve or highlight the background materials, like colloid, chondroid-myxoid stroma of pleomorphic adenoma, and extracellular mucin. With the combination of both Pap and diff-quick, it tends to give the cytopathologists enough weapons to attack the very challenging cases.

Thank you for all the discussions here, I would like to hear more opinions. 

 译陈博士：I need to thank Urbino for the very good comments. 感谢Urbino大夫的精彩评论，Let me give you an overview on this topic in the United States. 我给大家简述一下美国FNA的染色方法。I have visited many cytopathology labs in the country. 我参观了许多美国的细胞病理试验室，Pap stain and Diff-Quick (or other kind of Romanowsky stain) are the most commonly used stains on FNA cytology. 巴氏和Diff-Quick 或其它的 Romanowsky 染色是最常用的细针穿刺染色。H&E is clearly much less used. HE染色用的很少很少。One important fact is that if you submit a paper to any major journal of cytology in the US, if you just have the H&E stained pictures, your paper will have a hard time to get published. 不用HE还有一个重要的因素，如果你写细胞病理的文章，用HE染色的图片，在美国大点的细胞病理杂志上很难刊登。I would like to hear more discussions or comments regarding this topic. 我很愿意倾听更多的评论。Thank you!谢谢 Urbino。

 我科三种都用。

Diff-Quick 染色快。（只用1分钟）便于现场评价，并能应付大部分情况。看淋巴细胞效果也很好。个人感觉在判断细胞大小上比Pap更好，但看不清核仁，分辨组织细胞也比不上Pap。

Pap染色细胞看的最清楚，尤其是核仁。另外很容易鉴别角化上皮（红染），如多形性腺瘤、高分化鳞癌等，对确诊有帮助。

个人觉得HE没有太大的优点。当然，组织学片子看多了，细胞学HE有眼熟的好处。另外还有一个感受，HE细胞学看甲状腺乳头状癌的核内包涵体，核沟好像优于其他染色。

以上是些不正式的随感，见笑了。

 陈博士提出一个讨论题目：问中国国内病理学家们做细针穿刺时用什么染色方法，是HE， Diff-Quick 还是 巴氏染色，是三种都用？要么是用两种？或者是随便用？各有什么优缺点？

我们科只用HE，用HE的特点是符合长期看组织切片人的习惯。看 Diff-Quick 还是 巴氏染色不习惯，我看陈博士的细针穿刺染色有的是巴氏，有的是Diff-Quick ，不知为何用几种方法？