Volume: 13 Issue: 1
Year: 2025, Page: 35-41, Doi: https://doi.org/10.47799/pimr.1301.08
Received: March 10, 2025 Accepted: March 15, 2025 Published: April 1, 2025
Introduction: Fine Needle Aspiration (FNA) cytology is a well-established essential, basic diagnostic technique for investigating lumps and lesions at various anatomic sites. While performing FNA of the breast lumps a quick or rapid result is desirable to know the nature of the lump and allay the anxiety of the patient. Rapid On-Site Evaluation (ROSE) is useful to evaluate the cytological smears within a few minutes. This study aims to evaluate the utility of Field’s stain in ROSE of breast lesions in arriving at a diagnosis and its comparison to routine MGG ( May Grünwald Giemsa) stain. Materials and methods: This prospective observational study was conducted from July 2023 to December 2023 at a tertiary care center. A total of 89 cases with breast lumps were included. Previously diagnosed cases were excluded. All the cases were evaluated by ROSE using Field’s stain for preliminary diagnosis and compared later with MGG stain for final diagnosis. The categorization of cases was done as per IAC Yokohama System and further management was advised accordingly. Results: After first and repeat aspiration 62 (69.6%) cases were categorized as benign, 12 (13.4%) cases were found to be malignant whereas 8 (8.9%), 5 (5.6%), 2 (2.24%) cases were included in the suspicious, atypical and insufficient categories respectively. Categorization of the breast lumps by ROSE using Field stain was in complete agreement with the MGG stained smears and the final FNA diagnosis and showed no discrepancy. Conclusion: The use of Field’s stain for ROSE of breast lumps had comparable staining quality to MGG which resulted in accurate correlation between provisional and final cytologic diagnoses with the added advantage of rapid turnaround time. Field stain was hence found to be reliable, cost effective and time saving when used for ROSE of breast lumps. Hence the use of this readily available and affordable stain for ROSE of FNA smears, especially of breast lumps, can prove to be highly beneficial for prompt categorization and triaging of patients.
Keywords: Rapid on site evaluation, Breast, Field Stain, Prompt Categorization, Triage
Ammanagi, A S, Dombale, V D & Patil, Sharada S . 2012. On-site toluidine blue staining and screening improves efficiency of fine-needle aspiration cytology reporting. Acta Cytologica 56(4):347–351.
Joy, M P, Iyer, Venkateswaran K, Aron, Manju, Kapila, Kusum & Verma, Kusum . 2003. Rapid staining using toluidine blue: a reliable method for quick diagnosis in ultrasound-guided aspiration cytology. Indian Journal of Pathology & Microbiology 46(4):589–592.
Bandiera, A & Arrigoni, G . 2020. The impact of pathological analysis on endobronchial ultrasound diagnostic accuracy. Mediastinum 4:1–9.
Griffin, A C, Schwartz, Lauren Ende & Baloch, Zubair W . 2011. Utility of on-site evaluation of endobronchial ultrasound-guided transbronchial needle aspiration specimens. Cytojournal 8:20.
Suen, K C, Abdul-Karim, Fadi W, Kaminsky, David B, Layfield, Lester J, Theodore R Miller & Susan E Spires . 1999. Guidelines of the Papanicolaou Society of Cytopathology for the Examination of Cytologic Specimens Obtained from the Respiratory Tract. Diagnostic Cytopathology 21(1):61–69.
Nasuti, J F, Gupta, Prabodh K & Baloch, Zubair W . 2002. Diagnostic value and cost-effectiveness of on-site evaluation of fine-needle aspiration specimens: Review of 5,688 cases. Diagnostic Cytopathology1 27(1):1–4.
Santos, Gilda da Cunha, Ko, Hyang-Mi, Saieg, Mauro Ajaj & Geddie, William R . 2013. ‘The Petals and Thorns’’ of ROSE (Rapid On-Site Evaluation) Cancer Cytopathology 121(1):4–8.
Franck-A Ekoka Mbassi, Ghyslain Mombo-Ngoma, Ndoumba, Wilfrid Ndzebe, Yovo, Emmanuel K, Eberhardt, Kirsten A & Mbassi, Dorothea Ekoka . 2022. Performance of Field's Stain Compared with Conventional Giemsa Stain for the Rapid Detection of Blood Microfilariae in Gabon. American Journal of Tropical Medicine and Hygiene 107(2):383–387.
Chougule, M . 2020. Intraoperative Cytology Staining Technique. In: Neuropathology of Brain Tumors with Radiologic Correlates . (p. 361) Singapore: Springer
Field, A S . 2017. Fine Needle Aspiration Biopsy Cytology of Breast: A Diagnostic Approach Based on Pattern Recognition . In: A S Field & M R Zarka , eds. Practical Cytopathology: A Diagnostic Approach to Fine Needle Aspiration Biopsy. (pp. 147-231) Amsterdam: Elsevier
Schmidt, R L, Factor, R E, Affolter, K E, Cook, J B, Hall, B J & Narra, K K . 2012. Methods specification for diagnostic test accuracy studies in fine-needle aspiration cytology: a survey of reporting practice. American Journal of Clinical Pathology 137(1):132–141.
Oki, M, Saka, H, Kitagawa, C, Kogure, Y, Murata, N, Adachi, T & Ando, M . 2013. Rapid On-Site Cytologic Evaluation during Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration for Diagnosing Lung Cancer: A Randomized Study. Respiration 85(6):486–492.
Schmidt, R L, Walker, B S, Howard, K, Layfield, L J & Adler, D G . 2013. Rapid on-site evaluation reduces needle passes in endoscopic ultrasound-guided fine-needle aspiration for solid pancreatic lesions: a risk-benefit analysis. Digestive Diseases and Sciences 58(11):3280–3286.
Schmidt, Robert L, Witt, Benjamin L, Matynia, Anna P, Barraza, Gonzalo, Layfield, Lester J & Adler, Douglas G . 2013. Rapid On-Site Evaluation Increases Endoscopic Ultrasound-Guided Fine-Needle Aspiration Adequacy for Pancreatic Lesions. Digestive Diseases and Sciences 58(3):872–882.
Agrawal, N, Kothari, K, Tummidi, S, Sood, P & Agnihotri, M . 2021. Fine-Needle Aspiration Biopsy Cytopathology of Breast Lesions Using the International Academy of Cytology Yokohama System and Rapid On-Site Evaluation: A Single-Institute Experience. Acta Cytologica 65(6):463–477.
Ruth, S E & Malay, S . 2013. Rapid on-site evaluation of EUS-FNA by Cytopathologist: an experience of a tertiary hospital. Diagnostic Cytopathology 41(12):1075–1080.
Fahad, A, Girgis, S & Sandha, G S . 2009. Does onsite cytotechnology evaluation improve the accuracy of endoscopic ultrasound-guided fine-needle aspiration biopsy? Canadian Journal of Gastroenterology and Hepatology 23(1):26–30.
Lingen, Mark W, Kalmar, John R, Karrison, Theodore & Speight, Paul M . 2007. Critical evaluation of diagnostic aids for the detection of oral cancer. Oral oncology 44(1):10–22.
Kothari, Kanchan, Tummidi, Santosh, Agnihotri, Mona, Sathe, Pragati & Naik, Leena . 2019. This ‘Rose’ Has no Thorns-Diagnostic Utility of ‘Rapid On-Site Evaluation’ (ROSE) in Fine Needle Aspiration Cytology. Indian Journal of Surgical Oncology 10(4):688–698.
Kimambo, Asteria H, Vuhahula, Edda A, Philipo, Godfrey S, Mushi, Beatrice P, Mmbaga, Elia J, Katherine Van Loon & Ng, Dianna L . 2024. Rapid Onsite Evaluation for Specimen Adequacy and Triage of Breast Masses in a Low-Resource Setting. Archives of Pathology & Laboratory Medicine 148(1):9–17.
Yadav, Ranjan, Singh, Nikita, Bakna, Minu, Bhadkariya, Anand & Singh, Arjun . 2024. Cytomorphological spectrum of breast fine needle aspiration cytology using the International Academy of Cytology Yokohama System and evaluation of associated risk of malignancy–A retrospective study in a tertiary care cente. Surgical and Experimental Pathology 7(1):1–7.
Pillai, R N, Alex, Aleena, M S Narassima, Verma, Vivek, Shaji, Ajil & Pavithran, Keechilat . 2025. Economic burden of breast cancer in India, 2000-2021 and forecast to 2030. Scientific Reports 15:1–11.
©2025 (Swapnil Galat) et al. This is an open-access journal, and articles are distributed under the terms of the Creative Commons Attribution License CC-BY 4.0. (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original authors and source are credited.
Galat S, Nayak S, Tadvi F, Yedshikar V. Evaluating Field Stain for Rapid OnSite Evaluation in Fine Needle Aspiration Cytology of Breast Lesions: Diagnostic Utility with May-Grünwald Giemsa Staining. Perspectives in Medical Research. 2025;13(1):35-41 DOI: 10.47799/pimr.1301.08