Comparison between PAS and GMS stains for the diagnosis of onychomycosis

Journal of Cutaneous Pathology
Taher Reza Kermanshahi, Ronald Rhatigan

Abstract

Onychomycosis is the most common nail disease in adults. Periodic acid-Schiff (PAS) stain has been considered the most sensitive method for diagnosis. By comparing originally stained PAS slides (i.e. without repeating PAS) with newly stained Grocott methenamine-silver (GMS) slide, D'Hue et al. concluded that GMS is superior to PAS. We conducted a similar study with the addition of repeating PAS stain and compared the newly stained PAS and GMS slides in tandem. We performed both PAS and GMS stains on 30 clinically suspected onychomycosis cases. The presence or absence of fungal organisms was evaluated. The results were also compared with the original PAS stain. Twenty-two cases were positive with PAS, staining three cases more than GMS, which stained only 19 cases. The difference between the two stains is statistically insignificant. Repetition of GMS stain on these three cases (cutting in a deeper level in the paraffin block) resulted in positive results. Four out of 30 cases were negative with original PAS stain, but stained positive both with new PAS and GMS. PAS and GMS stains are quantitatively similar. Sensitivity of both methods can be increased by preparing two slides from different levels in the paraffin block.

References

Jun 15, 1999·Journal of the American Academy of Dermatology·R K Scher
Sep 15, 2000·Archives of Dermatology·M A LawryP S Romano
May 20, 2003·The British Journal of Dermatology·E-M ReisbergerR-M Szeimies
Aug 2, 2003·Journal of the American Academy of Dermatology·Jeffrey M WeinbergLily Najarian
Mar 12, 2008·Journal of Cutaneous Pathology·Zandra D'HueSteven D Billings
May 15, 2009·The New England Journal of Medicine·David de Berker

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Citations

Jul 27, 2011·Medical Mycology Journal·Takashi Harada
Dec 6, 2012·Dermatologic Therapy·Campbell L Stewart, Adam I Rubin
Feb 13, 2013·Journal of Cutaneous Pathology·Munir H IdrissDirk Elston
Apr 2, 2015·Dermatologic Clinics·Sasha StephenAdam I Rubin
Jun 8, 2017·Journal of Cutaneous Pathology·Christina WlodekDavid de Berker
Jun 10, 2020·Journal of Cutaneous Pathology·Sara C ShalinDavid S Cassarino
Oct 31, 2020·Clinics in Laboratory Medicine·Alvaro C Laga
Jun 17, 2021·World Journal of Clinical Oncology·Zhiyan FuHwajeong Lee

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