[Histonet] Re: Stain for HP

[Bob Richmond]

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