stains for Helicobacter pylori

<< Previous Message | Next Message >>
Content-Type:text/plain; charset=US-ASCII

I downloaded the PDF file that Vinnie Della Speranza recommended downloading 
from Sakura's

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

<< Previous Message | Next Message >>