An Introduction to Routine and Special Staining
Routine H&E staining and special stains play a critical role in tissue-based diagnosis or research. By colouring otherwise transparent tissue sections, these stains allow highly trained pathologists and researchers to view, under a microscope, tissue morphology (structure) or to look for the presence or prevalence of particular cell types, structures or even microorganisms such as bacteria.
In the histopathology laboratory, the term “routine staining” refers to the hematoxylin and eosin stain (H&E) that is used “routinely” with all tissue specimens to reveal the underlying tissue structures and conditions. The term “special stains” has long been used to refer to a large number of alternative staining techniques that are used when the H&E does not provide all the information the pathologist or researcher needs.
Why H&E Staining is Routine
Hematoxylin and Eosin (H&E) staining is used routinely in histopathology laboratories as it provides the pathologist/researcher a very detailed view of the tissue. It achieves this by clearly staining cell structures including the cytoplasm, nucleus, and organelles and extra-cellular components. This information is often sufficient to allow a disease diagnosis based on the organization (or disorganization) of the cells and also shows any abnormalities or particular indicators in the actual cells (such as nuclear changes typically seen in cancer). Even when advanced staining methods are used, the H&E stain still forms a critical part of the diagnostic picture as it displays the underlying tissue morphology which allows the pathologist/researcher to correctly interpret the advanced stain.
In a clinical histology laboratory, all specimens are initially stained with H&E and special or advanced stains are only ordered if additional information is needed to provide a more detailed analysis, for example to differentiate between two morphologically similar cancer types.
Because of the volume of H&E staining needed, most clinical laboratories use fully automated systems and manual staining is now rare.
The H&E stain uses two dyes: hematoxylin and eosin. This combination is used as the dyes stain different tissue elements.
Hematoxylin reacts like a basic dye with a purplish blue colour. It stains acidic, or basophilic, structure including the cell nucleus (which contains DNA and nucleoprotein) and organelles that contain RNA such as ribosomes and the rough endoplasmic reticulum.
Eosin is an acidic dye that is typically reddish or pink. It stains basic, or acidophilic, structures which includes the cytoplasm, cell walls, and extracellular fibres.
Hematoxylin is extracted from the logwood tree and purified. It is then oxidized and combined with a mordant (typically aluminium) to allow it to bind to the cell structures. Of the many hematoxylin preparations used in histology Gill’s hematoxylin, Harris's hematoxylin and Mayer's hematoxylin are the most popular.
Eosin is formed by a reaction between bromine and fluorescein. There are two eosin variants typically used in histology: eosin Y which is slightly yellowish and eosin B which is slightly bluish. Eosin Y is most popular.
特殊染剂一词传统上是指除 H&E 以外的任何染剂。它涵盖了各种可用于观察特定组织结构、组分甚至 H&E 染色无法识别的微生物的方法。
其他染色方法使用免疫组织化学法或原位杂交法来靶向特定蛋白或 DNA/RNA 序列。这些方法有时也被列为“特殊染剂”家族成员。但它们的方法和目的有很大差异，目前通常分成第三类别，称为“先进染剂”。
虽然有数百种特殊染剂可用于各种目的，但在临床组织学中只有少数在使用时是有规律的。各种染剂也意味着特殊染色不像 H&E 染色一样可自动化处理。尽管许多更大的实验室都会使用自动化仪器进行更常见的染色，但它们仍有一个手工染色空间。某些染剂的复杂性也会妨碍自动化的使用。
Some Common Special Stains
The images below illustrate some of the common special stains and their applications.
Steps to Better Special Stains
At Leica Biosystems, our vision is to advance cancer diagnostics and improve lives. One way we can achieve this vision is by helping improve staining quality. As we recognize that IHC and ISH quality doesn‘t begin at the stainer, this series looks at many different aspects of staining quality, and considers how future tests will influence improved diagnosis.
Understand the Stain
Know what you are trying to demonstrate with the stain you are performing.
Just “following the method” and not really knowing what should be seen in the finished section will lead to poor results.
Use a Positive Control
Always use a control slide known to contain the structure/ substance you are trying to demonstrate.
“If the structure/substance we are staining for is not visible in a slide, we assume it is not present.”
Use Accurate Timing
Use accurate timing.
Timing is always approximate. Inaccurate timing produces inconsistent results.
Consider Reagent Stability
Be aware of the shelf life of the reagents you are using. Some reagents or dye solutions deteriorate slowly while others are very unstable and must be made up fresh and used immediately. Others have to be left for some time to oxidize (ripen) before they can be used at all.
We assume all reagents can be used for an indefinite period.
Store Reagents Correctly
Store reagents correctly. Some require refrigeration because they are inclined to support the growth of fungi or molds. Others are light sensitive and require storage in the dark.
“All our reagents are stored on the shelf above the staining bench. Sometimes we see stray organisms in our sections.”
Adhere to the Method
Follow the protocol exactly.
Staff members achieve different results when supposedly using the same protocol.
Record Any Changes
Document any departure from the method you are using.
Sometimes when results are poor, it is difficult or impossible to work out why because protocol changes have not been recorded.
Standardize Washing Steps
Take particular care with washing steps. Standardize them as far as possible as they are frequently the cause of variable results.
Lab staff members use different washing techniques – some use vigorous agitation, others are much more gentle.
Set Up Microscope Carefully
Use microscopic control at crucial stages such as differentiation steps. Be aware of the effect of the microscope setup on the appearance of un-coverslipped (wet) sections; it can produce the appearance of false background staining.
For all methods, the level of staining is assessed by looking at the slide with the naked eye.