[Histonet] Re: G.I. biopsies and special stains

[Bob Richmond]

Kathy Machado at Danville, Virginia, Regional Medical Center asks:

>>I was wondering if other labs are "automatically" ordering special stains
and/or IHC on stomach biopsies and esophageal biopsies? Or do you wait
until H&E is screened?<<

A number of fairly small labs I've worked in in recent years all do
whatever studies they do at all on all biopsies. What they do varies
greatly - and usually the pathologist isn't allowed to ask for anything not
done on every biopsy.

Specifically: Every lab I've seen does either a stain or IHC for
Helicobacter on all gastric biopsies. A few do Alcian blue on all
esophageal biopsies. I've never seen a lab that did any stain routinely on
duodenal biopsies, where the pathologist is deliriously happy just to get
consistently interpretable H & E slides.

I've been asking around about routine CD3 on duodenal biopsies. A fair
number of labs do it, but G.I. pathologists caution you not to, because
there are no published standards for interpreting this stain.

As you're probably aware, the regulatory agency for the Virginias and the
Carolinas is planning to put a stop to all routine G.I. biopsy special
stains, and limit Helicobacter staining to 20% of gastric biopsies.

I think this is acceptable practice, provided that there is a serious
quality assurance program for G.I. biopsy slides, something I've yet to see.

Bob Richmond
Samurai Pathologist
Maryville TN