Also Alcian Yellow

-----Original Message-----
From: histonet-boun...@lists.utsouthwestern.edu 
[mailto:histonet-boun...@lists.utsouthwestern.edu] On Behalf Of Bob Richmond
Sent: Friday, October 19, 2012 5:01 AM
To: histonet@lists.utsouthwestern.edu
Subject: [Histonet] Re: Stain for HP

Staining gastric biopsy specimens for Helicobacter pylori: practice varies 
greatly in various labs I've worked in. One lab does a blue stain (generic 
equivalent of Diff-Quik II), while the other does immunohistochemistry, each of 
them on all specimens. I've also seen labs that did a full tissue Giemsa, and 
one that did a cresyl echt violet stain. Haven't seen a routine Warthin-Starry 
in many years. I think everyone bills every one of these stains they do.

There are still a few hold-outs for "real men can see 'em on the H & E".

As far as I know, no studies have been done comparing the sensitivity (we'll 
forget specificity) of the various methods. My personal opinion is that none of 
the dye or silver methods is conspicuously better than the others. Reading the 
blue stain is time-consuming; I use oil immersion magnification (which real men 
disdain) to confirm all positives (and confirm Helicobacter heilmannii, which I 
have seen once), and on all apparent negatives with acute inflammation. The IHC 
can be read rapidly with much less magnification.

I note that many pathologists sign out any bacteria they see in a blue stain as 
Helicobacter, including the frequent bugs that get carried down from the oral 
cavity as the scope advances. These pathologists should definitely switch to 
IHC.

So if I have one gastric biopsy case a day, I'm happy with the blue stain. If I 
have ten, I want IHC. If there is no inflammation, I can do without any stain.

Bob Richmond
Samurai Pathologist
Maryville TN

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