Abstract
We thank Drs. Elsheikh and Corbin for their interest in our article1 and for sharing their additional experience with this technique. They performed immunohistochemistry on cell-transferred touch imprints that had been stained using Diff-Quik (American Scientific Products, McGraw Park, IL) or Papanicolaou staining using various antibodies, with and without destaining and with and without antigen retrieval. They found a 100% concordance in staining results between Papanicolaou-stained cell-transferred pieces and formalin-fixed tissue (the gold standard) using antigen retrieval. When no antigen retrieval was used, false-negative results were encountered in approximately 15% of cell-transferred pieces. Similar results were noted in our previous study with estrogen receptor staining.2 However, we did not perform antigen retrieval for markers other than estrogen receptor because of the fact that putative utilization of antigen retrieval in nonformalin-fixed cytologic samples remains controversial and to the best of our knowledge, well controlled validation data for other markers are still lacking. It is likely that omission of the antigen retrieval step might have contributed to the negative staining results observed in some cell-transferred pieces in our study. Elsheikh and Corbin also reported that approximately 5–10% of cell-transferred pieces were lost or damaged during the destaining process. We routinely apply destaining on Papanicolaou-stained slides before immunocytochemical staining with all markers except estrogen receptor. This practice was based on the results of our study demonstrating that destaining may give rise to false-negative staining with estrogen receptor.2 It appears to us that omitting destaining, coupled with applying antigen retrieval, might yield better staining sensitivity. However, a well controlled study is needed to validate this observation. The reliability of air-dried, Diff-Quik-stained tissue for immunostaining is limited. The high rate of false negativity and high background staining reported by Elsheikh and Corbin attest to this finding.
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