ÖZOFAGUS BİYOPSİLERİNDE HEMATOXYLIN & EOSIN (H&E) BOYAMASININ VE PERİYODİK ASİT SCHIFF-ALCIAN BLUE (PAS-AB) HİSTOKİMYASININ İNTESTİNAL METAPLAZİ AÇISINDAN KARŞILAŞTIRILMASI

Abstract

Barret özofagusu, özofagus adenokarsinomları için öncül bir lezyon olarak kabul edilir. Endoskopik incelemenin önemli yer tuttuğu Barret özofagusu için histopatolojik inceleme gereklidir. Histopatolojik incelemelerde hematoksilen & eozin (H&E) ve alcian blue (AB) ile intestinal metaplazi ortaya çıkarılır. Bu konuda 2 farklı görüş mevcut. Bunlardan biri, rutin H&E boyamasında intestinal metaplaziden şüphelenildiğinde AB veya Periodic acid schiff alcian blue (PAS-AB) için histokimyasal inceleme yapmak, diğeri ise tüm özofagus biyopsilerinde H&E boyaması yanıs ısra rutin olarak AB veya PAS-AB ile histokimyasal inceleme yapmaktır. Bu çalışma, intestinal metaplazinin değerlendirilmesinde H&E ve AB boyama yöntemlerinin rolünü ortaya koymayı amaçlamaktadır. Çalışmaya 200 özofagus endoskopik biyopsisi dahil edildi. Biyopsi kesitleri iki patolog tarafından kör olarak yeniden değerlendirildi. H&E ve Periodic acid schiff alcian blue (PAS-AB) boyaları sensitivite, spesifite ve pozitif prediktivite açısından karşılaştırıldı. İstatistiksel analizde intestinal metaplazinin değerlendirilmesinde H&E ve AB arasında güçlü bir korelasyon bulundu (Kendall, p = 0,00; r = 0, 81). PAS-AB boyalı kesitlerde sensitivite %100, spesifite % 100, pozitif prediktivite % 100, negatif prediktivite % 100 iken; H&E değerlendirmesinde, sensitivite % 79, spesifite %100, pozitif prediktivite %100, negative prediktivite %82.6’dır. İntestinal metaplazinin histopatolojik değerlendirmesinde temel amaç pozitif olguları tespit etmektir. İntestinal metaplazinin yokluğu daha az önemli olduğundan H&E kesitlerde gözlenen % 100 spesifite ve pozitif prediktivite değerleri yerine daha yüksek sensitivite ve negatif prediktivite değerleri tercih edilmelidir. Bu koşullar göz önüne alındığında, AB içeren yardımcı bir histokimya kullanmak mantıklı görünmektedir.

Keywords

• İntestinal metaplazi
• Hematoksilen& Eozin
• H&E
• Alcian blue
• AB

COMPARISON OF HEMATOXYLIN & EOSIN (H&E) STAINING AND PERIODIC ACID SCHIFF-ALCIAN BLUE (PAS-AB) HISTOCHEMISTRY IN ESOPHAGEAL BIOPSIES IN TERMS OF INTESTINAL METAPLASIA

Abstract

Barret esophagus is considered as a precursor lesion for esophageal adenocarcinomas. Histopathological examination is required for the barret esophagus, where endoscopic examination takes an important place. Intestinal metaplasia is revealed with hematoxylin & eosin (H&E) and alcian blue (AB) in histopathological examinations. There are 2 different opinions on this issue. One of them is to perform histochemical examination for AB or PAS-AB when intestinal metaplasia is suspected in routine H&E staining, while the other is to perform histochemical examination for routine AB or Periodic acid schiff alcian blue (PAS-AB) in all esophageal biopsies with H&E section. This study aims to reveal the roles of H&E and AB staining methods in the assessment of intestinal metaplasia. 200 esophageal endoscopic biopsies were included in the study. Sections of the biopsies were re-evaluated blindly by two pathologists. H&E and PAS-AB stains were compared in terms of sensitivity, specificity, positive predictivity. In statistical analysis, a strong correlation was found between H&E and AB in the evaluation of intestinal metaplasia (Kendall, p = 0.00; r = 0, 81). In H&E evaluation, sensitivity is 79%, specificity 100%, positive predictivity 100%, negative predictivity 82.6%, while sensitivity is 100%, specificity 100%, positive predictivity 100%, negative predictivity 100% in PAS-AB stained sections. The main goal in the histopathological evaluation of intestinal metaplasia is to detect positive cases. Since absence of intestinal metaplasia means less importance, higher sensitivity and negative predictivity values should be preferred rather than 100% specificity and positive predictivity values observed in H&E sections. Considering these conditions, it seems rational to use an auxiliary histochemistry containing AB.

Keywords

• Intestinal metaplasia
• Hematoxylin & Eosin
• H&E
• Alcian Blue
• AB

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