stains for Helicobacter pylori
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From: | RSRICHMOND@aol.com |
To: | HistoNet@pathology.swmed.edu |
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Content-Type: | text/plain; charset=US-ASCII |
I downloaded the PDF file that Vinnie Della Speranza recommended downloading
from Sakura's www.sakuraus.com:
A comparison of staining methods for Helicobacter pylori. Kim
Rhatigan-Drexler, MA, HTL (ASCP), histology supervisor, SUNY. In Histo-Logic,
April first, 1999.
This study examined a single gastric biopsy specimen, stained with six
methods: Giemsa, Gimenez' carbol fuchsin-malachite green, a Dieterle
microwave method, cresyl echt violet, Sayeed's methylene
blue-PAS-hematoxylin, and toluidine blue-Alcian yellow. Nice photomicrographs
illustrate each stain.
"Three independent observers" looked at the slides, and that is all the
information we get about who looked at the slides, what they looked through,
what they looked for, and what they saw.
No simple blue stain (such as Diff-Quik II or toluidine blue) was included.
It is totally unclear whether the more complex and time-consuming stains are
more sensitive (more likely to find bacteria), more specific (less likely to
misidentify crud as Helicobacter), or whether observer time is decreased (as
it might be, for example, if a stain could be reliably reviewed without
time-consuming oil immersion microscopy). For that matter, it remains unclear
whether it is worthwhile to do a special stain at all, or whether looking for
bugs in the H & E is sufficient.
The paper is nice-looking and in clear English, but it really is of no value
to the pathologist asking the question: to look for Helicobacter pylori in
gastric biopsy material, is it worthwhile for me to get a routine special
stain done, and if so, which one? Close to half the article is taken up with
clinical information which, while very interesting and informative, is
irrelevant to the matter at hand and should have been compressed into a few
terse sentences, or else focused on the diagnosis of Helicobacter pylori
gastritis and how histologic studies fit into the total array of tests
available to the physician caring for the patient.
The gastroenterologists begrudge us the stain, and as a result often we cannot
bill for the bacterial stain at all. The homeliest toluidine blue stain and
the most fiendishly complex silver impregnation technique are each billed as
a CPT 88312.
The author of this paper fails to ask herself: who are my readers? What do
they need to know about Helicobacter staining? It's one more sad example of
the lack of communication between pathologists and histotechnologists that is
slowly bringing both professions to an impasse.
Bob Richmond
Samurai Pathologist
Knoxville TN
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