“Agar Cell-Suspension”: A novel technique for processing clear specimens

Context: Clear cytology specimens are processed by cytocentrifugation which is preferred over membrane filters (MF). Although both techniques are expensive, cytocentrifugation is less tedious and may cause cellular distortion. Aim: To standardize “Agar cell-suspension” (ACS) an innovative, simple, cost-effective technique to process clear specimens. Methods and Materials: About 93 clear specimens (65 urine, 15 effusion, 12 CSF, and 1 bronchial lavage) were processed by both cytocentrifugation and ACS. The sample was centrifuged in two tubes; one was used for ACS and other for cytocentrifugation. ACS smears were prepared by mixing one drop of 0.5% agar solution with the last drop of the centrifugate. Smears were fixed in methanol and stained by Papanicolaou staining method. ACS smears were compared with cytocentrifuged smears (CS) and evaluated for cellularity, cytomorphology preservation, staining quality, time, and cost. Results: As compared to CS smears, ACS smears showed better cellularity in 16.1%, comparable in 53.7%, and less in 30.1%. All ACS smears (100%) showed well-preserved cytomorphology as compared to 96.7% CS. Staining quality was optimal in 96.7% ACS smears against 91.3% CS. Both techniques took equal time. The additional cost of ACS was only 0.03 INR compared to 12.50 INR for CS. Conclusions: ACS is an innovative, simple, easy, and cost-effective technique for processing clear specimens. It gives equally good results comparable to cytocentrifugation in terms of cellularity and staining quality. ACS does not cause cell distortion or air-drying as seen in some CS. Thus, ACS is a superior alternative to cytocentrifugation.