ÖZOFAGUS BİYOPSİLERİNDE HEMATOXYLIN & EOSIN (H&E) BOYAMASININ VE PERİYODİK ASİT SCHIFF-ALCIAN BLUE (PAS-AB) HİSTOKİMYASININ İNTESTİNAL METAPLAZİ AÇISINDAN KARŞILAŞTIRILMASI
Öz
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.
Anahtar Kelimeler
Kaynakça
- Bujanda DE, Hachem C. Barrett's Esophagus. Mo Med. 2018 May- Jun;115(3):211-3. PMID: 30228724; PMCID: PMC6140158.
- Burke ZD, Tosh D. Barrett’s metaplasia as a paradigm for understanding the development of cancer. Curr Opin Genet Dev 2012;22:494-9.
- De Palma GD. Management strategies of Barrett esophagus, World J Gastroenterol 2012;18:6216-25.
- Faller G, Borchard F, Ell C, et al. Histopathological diagnosis of Barrett’s mucosa and associated neoplasias: results of a consensus conference of the Working Group for Gastroenterological Pathology of the German Society for Pathology on 22 September 2001 in Erlangen. Virchows Archiv : an international journal of pathology. 2003;443:597–01.
- Fiocca R, Mastracci L, Milione M, Parente P, Savarino V; Gruppo Italiano Patologi Apparato Digerente (GIPAD); Società Italiana di Anatomia Patologica e Citopatologia Diagnostica/International Academy of Pathology, Italian division (SIAPEC/IAP). Microscopic esophagitis and Barrett's esophagus: the histology report. Dig Liver Dis. 2011 Mar;43 Suppl 4:S319-30. doi: 10.1016/S1590-8658(11)60588-4.
- Gerson LB, Shetler K, Triadafilopoulos G. Prevalence of Barrett’s esophagus in asymptomatic individuals. Gastroenterology. 2002;123:461–7.
- Haggitt RC, Dean PJ. Adenocarcinoma in Barrett's epithelium In: Spechler SJ, Goyal RK, eds. Barrett's esophagus: pathophysiology, diagnosis, and management. New York: Elsevier, 1985;153–66.
- Harrison R, Perry I, Haddadin W, et al. Detection of intestinal metaplasia in Barrett’s esophagus: an observational comparator study suggests the need for a minimum of eight biopsies. The American journal of gastroenterology. 2007;102:1154–61.
- Hayeck TJ, Kong CY, Spechler SJ, Gazelle GS, Hur C. The prevalence of Barrett’s esophagus in the US: estimates from a simulation model confirmed by SEER data. Dis Esophagus 2010;23:451-7.
- Hvid-Jensen F, Pedersen L, Drewes AM, Sorensen HT, Funch-Jensen P. Incidence of adenocarcinoma among patients with Barrett’s esophagus. The New England journal of medicine. 2011;365:1375–83.
- Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013;108:308-28.
- Kelty CJ, Gough MD, Van Wyk Q, Stephenson TJ, Ackroyd R. Barrett’s oesophagus: intestinal metaplasia is not essential for cancer risk. Scand J Gastroenterol. 2007;42:1271–4.
- Locke GR 3d, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3d. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112:1448–56.
- Mukaisho KI, Kanai S, Kushima R, et al. Barretts's carcinogenesis. Pathol Int. 2019 Jun;69(6):319-30. doi: 10.1111/pin.12804.
- Naini BV, Souza RF, Odze RD. Barrett’s Esophagus: A Comprehensive and Contemporary Review for Pathologists. Am J Surg Pathol 2016;40:e45-66.
- Pech O. Screening and Prevention of Barrett's Esophagus. Visc Med. 2019 Aug;35(4):210-214. doi: 10.1159/000501918.
- Peters Y, Al-Kaabi A, Shaheen NJ, et al. Barrett oesophagus. Nat Rev Dis Primers. 2019 May;5((1)):35.
- Qureshi AP, Stachler MD, Haque O, Odze RD. Biomarkers for Barrett's esophagus ‐ a contemporary review. Expert Rev Mol Diagn 2018;18: 939–46.
- Shaheen NJ, Falk GW, Iyer PG, Gerson LB, American College of G. ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus. Am J Gastroenterol 2016;111:30-50.
- Shalauta MD, Saad R. Barrett's esophagus. Am Fam Physician. 2004 May 1;69(9):2113-8. PMID: 15152957.
- Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology 2011;140(3): e18-e52.
- Spechler SJ, Souza RF. Barrett's esophagus. N Engl J Med. 2014 Aug 28;371(9):836-45. doi: 10.1056/NEJMra1314704.
- Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett's esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy. 2017 Feb;49((2)):191–8.
COMPARISON OF HEMATOXYLIN & EOSIN (H&E) STAINING AND PERIODIC ACID SCHIFF-ALCIAN BLUE (PAS-AB) HISTOCHEMISTRY IN ESOPHAGEAL BIOPSIES IN TERMS OF INTESTINAL METAPLASIA
Öz
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.
Anahtar Kelimeler
Intestinal metaplasia Hematoxylin & Eosin H&E Alcian Blue AB
Kaynakça
- Bujanda DE, Hachem C. Barrett's Esophagus. Mo Med. 2018 May- Jun;115(3):211-3. PMID: 30228724; PMCID: PMC6140158.
- Burke ZD, Tosh D. Barrett’s metaplasia as a paradigm for understanding the development of cancer. Curr Opin Genet Dev 2012;22:494-9.
- De Palma GD. Management strategies of Barrett esophagus, World J Gastroenterol 2012;18:6216-25.
- Faller G, Borchard F, Ell C, et al. Histopathological diagnosis of Barrett’s mucosa and associated neoplasias: results of a consensus conference of the Working Group for Gastroenterological Pathology of the German Society for Pathology on 22 September 2001 in Erlangen. Virchows Archiv : an international journal of pathology. 2003;443:597–01.
- Fiocca R, Mastracci L, Milione M, Parente P, Savarino V; Gruppo Italiano Patologi Apparato Digerente (GIPAD); Società Italiana di Anatomia Patologica e Citopatologia Diagnostica/International Academy of Pathology, Italian division (SIAPEC/IAP). Microscopic esophagitis and Barrett's esophagus: the histology report. Dig Liver Dis. 2011 Mar;43 Suppl 4:S319-30. doi: 10.1016/S1590-8658(11)60588-4.
- Gerson LB, Shetler K, Triadafilopoulos G. Prevalence of Barrett’s esophagus in asymptomatic individuals. Gastroenterology. 2002;123:461–7.
- Haggitt RC, Dean PJ. Adenocarcinoma in Barrett's epithelium In: Spechler SJ, Goyal RK, eds. Barrett's esophagus: pathophysiology, diagnosis, and management. New York: Elsevier, 1985;153–66.
- Harrison R, Perry I, Haddadin W, et al. Detection of intestinal metaplasia in Barrett’s esophagus: an observational comparator study suggests the need for a minimum of eight biopsies. The American journal of gastroenterology. 2007;102:1154–61.
- Hayeck TJ, Kong CY, Spechler SJ, Gazelle GS, Hur C. The prevalence of Barrett’s esophagus in the US: estimates from a simulation model confirmed by SEER data. Dis Esophagus 2010;23:451-7.
- Hvid-Jensen F, Pedersen L, Drewes AM, Sorensen HT, Funch-Jensen P. Incidence of adenocarcinoma among patients with Barrett’s esophagus. The New England journal of medicine. 2011;365:1375–83.
- Katz PO, Gerson LB, Vela MF. Guidelines for the diagnosis and management of gastroesophageal reflux disease. Am J Gastroenterol 2013;108:308-28.
- Kelty CJ, Gough MD, Van Wyk Q, Stephenson TJ, Ackroyd R. Barrett’s oesophagus: intestinal metaplasia is not essential for cancer risk. Scand J Gastroenterol. 2007;42:1271–4.
- Locke GR 3d, Talley NJ, Fett SL, Zinsmeister AR, Melton LJ 3d. Prevalence and clinical spectrum of gastroesophageal reflux: a population-based study in Olmsted County, Minnesota. Gastroenterology. 1997;112:1448–56.
- Mukaisho KI, Kanai S, Kushima R, et al. Barretts's carcinogenesis. Pathol Int. 2019 Jun;69(6):319-30. doi: 10.1111/pin.12804.
- Naini BV, Souza RF, Odze RD. Barrett’s Esophagus: A Comprehensive and Contemporary Review for Pathologists. Am J Surg Pathol 2016;40:e45-66.
- Pech O. Screening and Prevention of Barrett's Esophagus. Visc Med. 2019 Aug;35(4):210-214. doi: 10.1159/000501918.
- Peters Y, Al-Kaabi A, Shaheen NJ, et al. Barrett oesophagus. Nat Rev Dis Primers. 2019 May;5((1)):35.
- Qureshi AP, Stachler MD, Haque O, Odze RD. Biomarkers for Barrett's esophagus ‐ a contemporary review. Expert Rev Mol Diagn 2018;18: 939–46.
- Shaheen NJ, Falk GW, Iyer PG, Gerson LB, American College of G. ACG Clinical Guideline: Diagnosis and Management of Barrett’s Esophagus. Am J Gastroenterol 2016;111:30-50.
- Shalauta MD, Saad R. Barrett's esophagus. Am Fam Physician. 2004 May 1;69(9):2113-8. PMID: 15152957.
- Spechler SJ, Sharma P, Souza RF, Inadomi JM, Shaheen NJ. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology 2011;140(3): e18-e52.
- Spechler SJ, Souza RF. Barrett's esophagus. N Engl J Med. 2014 Aug 28;371(9):836-45. doi: 10.1056/NEJMra1314704.
- Weusten B, Bisschops R, Coron E, et al. Endoscopic management of Barrett's esophagus: European Society of Gastrointestinal Endoscopy (ESGE) Position Statement. Endoscopy. 2017 Feb;49((2)):191–8.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Cerrahi |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2021 |
| Gönderilme Tarihi | 16 Haziran 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 4 Sayı: 2 |
Kaynak Göster
