[Histonet] Identifying staining methods

[Bryan Llewellyn]

Hi all,
I received the following communication in November last year, and am posting
it with permission.  My response is below it, after the line of asterisks.
I have never heard the subject of standard identification of staining
methods raised before.  Could I get you all to read the letter and my reply,
then comment on either the specifics in the e-mail, or the subject of
identifying specific staining methods from the jumble of names by which they
go.  Would there be any benefit to a naming scheme to identify specific
staining methods and their variants, or do you think it would be a
completely unattainable goal, or a pointless exercise, or something else?.

If you want to know what LOINC is go to :http://www.loinc.org

Awaiting with bated breath,

Bryan Llewellyn




----- Original Message -----
From: "Jeremiah H Sable" <jsable <@t> csc.com>
To: "Bryan D. Llewellyn" <bryand <@t> netbistro.com>
Sent: Tuesday, November 25, 2003 9:15 AM
Subject: Questions about stains


Hi, I've been helping develop a public health information system for the
Centers for Disease Control in Atlanta, GA.  It uses the LOINC coding system
for laboratory test names, and I've found some ambiguous and redundant names
for stain methods.  I've done a lot of web searching and found the Stains
File to be the most organized and helpful site.

I'm hoping to get a little more "un-confused" before I send my suggestions
on to the LOINC developers.  My questions concern three groups of stains:
Kinyoun, Gomori, and Silver stains.

1. Kinyoun stain:  LOINC has a stain method called "Kinyoun stain."  It also
has the following methods:
    "Kinyoun hematoxylin stain"
    "Kinyoun iron hematoxylin stain"
    "Kinyoun acid fast stain"
    "Modified Kinyoun acid fast stain"

My question: Is the term "Kinyoun stain" meaningful without further
qualification?  Or would it be better to delete "Kinyoun stain" from the
list of LOINC methods?

2. Gomori stains:  LOINC has a stain method called "Gomori stain".  This
seems ambiguous because "Gomori stain" can mean a Methenamine silver stain
or a Trichrome stain.  I've also seen references to "Gomori reticulin
stain," and a "Gomori stain for pancreatic island cells."  (Also collagen
and cartillage stains, which might be the same as the Gomori reticulin
stain.)

Can you help clarify this?  How many types of Gomori stains are there? Are
there unambiguous names for the methods referred to as Gomori stains?

3. Silver stains:  LOINC has nine silver stains:
    Silver impregnation stain, Dieterle
    Silver stain
    Silver stain, Grimelius
    Silver stain, Fontana-Masson
    Silver stain, Warthin-Starry
    Methenamine silver nitrate stain
    Methenamine silver stain, Grocott
    Methenamine silver stain, Jones
    Silver nitrate stain

My impressions about this list are:

1. "Methenamine silver nitrate stain" should be renamed "Methenamine silver
stain."  (I think all Methenemain silver stains have silver nitrate in the
recipe.)
2. "Silver nitrate stain" is redundant and actually means "Methenamine
silver stain."

Is this correct?

Is Grocott's Methenamine silver stain a modification of the Gomori Silver
Methenamine stain (which isn't on the list)? Should "Silver methenamine
stain, Gomori" be added to the list?

Also, Is "Silver impregnation stain" just another way of saying "Silver
stain?"  Should the "Silver impregnation stain, Dieterle" be renamed "Silver
stain, Dieterle"?

These LOINC names for silver stains are very confusing to me and I'd
appreciate any information that might help.

Much appreciated,

JS
-------------------------------------------
Jerry Sable,  NEDSS Vocabulary


**********************************



Hello,
You raise an interesting subject.  As far as I know there is no standard way
to designate specific staining methods, so it tends to be at the whim of the
person referencing them.  Most people use the name of the person who
published the technique, but not always.  Usually the reference includes the
tissue component to be stained, but again, not always.  Some are referenced
colloquially due to their very common use, since nearly all
histotechnologists would know what method is meant.

I have never seen this subject raised before, and I would like to refer it
to a histology discussion group (Histonet), composed of many
histotechnologists with some pathologists and others.  may I have your
permission to do this with your query and my response below?

Incidentally, I am not familiar with LOINC.  What is it?

Kinyoun's hematoxylin and Kinyoun's iron hematoxylin could refer to the same
solution, depending on whether Kinyoun ever published a hematoxylin using a
mordant other than iron.  If one was published (I don't know) then it could
refer to two different solutions.  The second designation (Kinyoun's iron
hematoxylin) is preferable as an identification.

Kinyoun's acid fast stain and Modified Kinyoun acid fast stain would likely
refer to two slightly different solutions (or procedures, since "stain" is
sometimes used to refer to the solution and sometimes to the technique in
which the solution is used), the modified one being slightly changed from
the original by someone else, nnamed.

My opinion is that a designation must identify, if it does not, then it is
useless.  The term "Kinyoun's stain", with no further identification to help
in choosing between alternatives, is useless and can cause confusion.  I
would remove it.

Gomori published several staining methods, many completely unrelated to each
other.  The term "Gomori's stain" is useless in identifying any of his
techniques.  To identify the particular method recommended it should be
followed by some further identification, either the tissue element being
targeted, or some reference to the underpinnings to the technique, i.e.
Gomori's silver impregnation for reticulin, Gomori's aldehyde fuchsin for
pituitary cells and so on.  This should make it clear.

Silver stains are very common.  Strictly speaking they are not stains but
impregnations, although most histotechnologists refer to them as stains, I
am sure.  Still, formal documents should perhaps use the word impregnation.
The term "Silver stain" simply means that a source of silver has been used
in a method, nothing more.  When it is followed by a name it refers to a
specific method.  Again, using the name of the published author is very
common.  When the term "methenamine silver" is included it refers to those
methods which incorporate methenamine into the silver solution.

Not all silver stains are the same.  There are those that use silver nitrate
alone, those that use silver nitrate and ammonia, and those that use silver
nitrate and methenamine.  Not all silver solutions contain methenamine, so
your assumption that "methenamine silver nitrate stain" and "methenamine
silver stain" mean the same thing is correct.  Your assumption that  "silver
nitrate stain" means the same as "methenamine silver stain" is not correct.

Gomori's and Grocott's methenamine silver methods are very similar, however,
rather than refer to methenamine silver stains by author's name, perhaps you
should consider listing by target, i.e. "Methenamine silver impregnation for
fungi, basement membranes and carbohydrates".  This covers the three common
uses for these techniques by any variant, and they are fairly similar
anyway.

Dieterle's method demonstrates microorganisms (spirochetes and others).
Perhaps "Silver impregnation for microrganisms, Dieterle", or "Silver
impregnation for spirochetes, Dieterle", would be clearer.

If you would like some more clarification, please ask.

Bryan Llewellyn