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Editor,—It is pleasing to see Toleet al1 having success with impression cytology (IC) in the diagnosis of ocular surface squamous neoplasia (OSSN) and we thank the authors for their acknowledgment of our work.
We continue to use the small cellulose acetate strips because they offer greater sampling flexibility. However, the Biopore membrane could have practical advantages if samples are to be collected from a variety of locations and transported to the laboratory. We strongly recommend the use of the Papanicolaou stain when examining cytological preparations for this squamous neoplasm because the keratinised group offers the biggest challenge to diagnosis. Neither the Giemsa nor haematoxylin and eosin stains used by Tole et al are likely to be as helpful.
Tole et al note that the accuracy of IC in their hands is very similar to that quoted in our original publication and their results are also similar to our later report on a much larger group of intraepithelial and invasive histologically confirmed cases.2 It seems reasonable to assume that both cellulose acetate strips and the Biopore membrane are equally efficient at sampling the ocular surface if the lesion is easily accessible.
The difficulty in interpretation of these specimens caused by the paucity of literature relating to cytological criteria is noted by Toleet al. A recent publication on the cytomorphology of OSSN3 may be helpful. It describes the cytological diversity seen in histologically confirmed impressions from 152 different patients including 23 with invasive SCC of the ocular surface.
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