I appreciate everyone's comments re: Histogel and home grown approaches to
cell blocks. I've done the agar routine before and I do have one of those
forceps warmers with the wells Vinnie. How long before little critters begin
growing in there over long term storage I wonder. The great thing about
Histonet is that the Richard Allen rep called the next morning to send a
sample after monitoring the net and hearing my question. Thanks to her and
to all those who make it possible.  VENDORS- if all these nasty emails are
casuing problems for you vendors, please  SUBSCRIBE DIGEST instead. Then
you'll only get one long tirade a day instead of hundred of little hissy
fits.

As for the Samurai Doc's remarks- it could well be an appalling decision in
certain institutions  but it is right for us. I would like to explain
further how our decision will affect patient care. We do approximately 700
cytologies annually, about ten percent of these are Paps from clinic and ER
patients, who now may well get Thin Preps if the reference lab provides it.
The rest are in house urines, sputa, bronchial washings or a rare BAL,
pleural and abdominal fluids, and various lavages for staging purposes and
FNA of deep sites only, no breast, head and neck, thyroid or nodal FNAS.
All FNA's are kept in house and stained with H and E.

95% of our urines show no significant pathology other than hematuria,
crystals, etc. The  urothelial neoplasm yield on our patient population is
nil, I guess the urologists use reference labs for screening the bladder ca
candidates before admission and urinalysis answers the questions on urines
submitted to us, the in house patients by and large.

All CSF are reported from the Romanowski stained cytospins in hematology.
I've never seen a CSF stained with Pap that gave better data and that wasn't
out shone by the Diff Quick.  I've also never seen a cell block from a CSF.

We spin everything with 50 ml tubes if need be.
BAL's are quick spun and a Diffquick examined for PCP, cytomegalo, and in
Micro a gram stain smear. Cell block provides material for stains if needed.
Classic PCP is beautiful on a Diff Quick and TB show a negative image of the
organism. Try that with a Pap stain.

Body cavity washings have all sediment and floating solids submitted.
Immunostains on the cell block eliminates QC issues of using paraffin
control material with smears.

Bronchial washings are examined in their entirety, subject to plane of
section limitations, there's always levels. I've had about ten bronchoscopy
cases in my career where the only thing with the bronchogenic ca was the
cell block, brushings and washing smears and biopsy negative. All sediment
and gunk is submitted. Same for sputa, well maybe not all sputa  but still
much more than you can smear between two slides.

There's no law that says you can't run a Diffquick air dried smear on a
pleural or other fluid to assess cellularity and if you happen to discover a
monstrocellular bubbly adenocarcinoma, soooo.......It's not hard to learn
Diff Quick and forget Pap

Cheers all
Jeff Silverman
Soutside Hospital
Bay Shore NY