- Volume 15 Issue 16
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Modified Toluidine Blue: an Alternative Stain for Helicobacter pylori Detection in Routine Diagnostic Use and Post-eradication Confirmation for Gastric Cancer Prevention
- Sakonlaya, Dussadee (Department of Pathology, Faculty of Medicine, Thammasat University) ;
- Apisarnthanarak, Anucha (Department of Internal Medicine, Faculty of Medicine, Thammasat University) ;
- Yamada, Nobutaka (The Second Department of Pathology, Nippon Medical School) ;
- Tomtitchong, Prakitpunthu (Department of Surgery, Faculty of Medicine, Thammasat University)
- Published : 2014.08.30
Background: Modified toluidine blue staining (MTBs) is a simple, inexpensive and time saving method to detect H. pylori in gastric biopsy specimens. As a metachromatic stain, it simultaneously highlights intestinal metaplasia, a gastric cancer precancerous lesion. The aim of this study was to assess the reliability of MTBs compared with hematoxylin-eosin (H&E) for H. pylori detection using immunoperoxidase staining as the gold standard. This technique would be beneficial for a routine diagnosis and confirmation of H. pylori eradication in developing countries where endoscopic-based approaches are dominant. Materials and Methods: Esophagogastroduodenoscopy with triple site gastric biopsies was undertaken in 207 dyspeptic patients at Thammasat University Hospital, Thailand between 1997 and 1999. H&E, MTBs and immunoperoxidase staining were applied to each specimen. The presence or absence of H. pylori with each stain was interpreted separately and the sensitivity, specificity, positive and negative predictive values of H&E and MTBs were calculated. Results: A total of 282 specimens from 207 patients were evaluated. Using immunoperoxidase staining, organisms were positive in 117 specimens (41%). MTBs proved almost equally sensitive as immunoperoxidase (99%) and significantly more sensitive than H&E (85%). It has comparable specificity (96% vs 96%), PPV (95% vs 94%), and NPV (99% vs 90%) to H&E, using immunoperoxidase staining as gold standard. MTBs compared with immunoperoxidase staining, is cheaper (2 USD vs 12 USD) and faster (20 min vs 16 hrs) compared to immunoperoxidase staining. Conclusions: MTBs is effective, economical and easy to use in daily practice for the detection of H. pylori in gastric biopsy specimens. In addition to saving time in evaluating H. pylori associated gastritis, with a high sensitivity and ability to demonstrate intestinal metaplasia, the technique may have a role in confirmation of H. pylori eradication for gastric cancer prevention in a developing country setting.
Helicobacter pylori;histopathology;intestinal metaplasia;modified toluidine blue
- Barthel JS, Everett ED (1990). Diagnosis of Campylobacter pylori infections: the "gold standard" and the alternatives. Rev Infect Dis, 12, 107-14. https://doi.org/10.1093/clinids/12.Supplement_1.S107
- Caselli M, Trevisani L, Tursi A, et al (1997). Short-term lowdose triple therapy with azithromycin, metronidazole and lansoprazole appears highly effective for the eradication of Helicobacter pylori . Eur J Gastroenterol Hepatol, 9, 45-8. https://doi.org/10.1097/00042737-199701000-00012
- Cook HC (1996). Carbohydrate. In "Theory and Practice of Histological Techniques", Eds Bancroft JD and Stevens A. Churchill Livingstone, New York pp 173-211.
- Cutler AF, Havstad S, Ma CK, et al (1995). Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection. Gastroenterology, 109, 136-41. https://doi.org/10.1016/0016-5085(95)90278-3
- de Boer WA (1997). Diagnosis of Helicobacter pylori infection. Review of diagnostic techniques and recommendations for their use in different clinical settings. Scand J Gastroenterol, 223, 35-42.
- Dixon MF, Genta RM, Yardley JH, et al (1996). Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol, 20, 1161-81.
- Dursun M, Yilmaz S, Yukselen V, et al (2004). Evaluation of optimal gastric mucosal biopsy site and number for identification of Helicobacter pylori , gastric atrophy and intestinal metaplasia. Hepatogastroenterology, 51, 1732-5.
- el-Zimaity HM, Wu J, Graham DY (1999). Modified Genta triple stain for identifying Helicobacter pylori. J Clin Pathol, 52, 693-4. https://doi.org/10.1136/jcp.52.9.693
- Ford AC, Forman D, Hunt RH, et al (2014). Helicobacter pylori eradication therapy to prevent gastric cancer in healthy asymptomatic infected individuals: systematic review and meta-analysis of randomised controlled trials. BMJ, 348, 3174. https://doi.org/10.1136/bmj.g3174
- Genta RM, Robason GO, Graham DY (1994). Simultaneous visualization of Helicobacter pylori and gastric morphology: a new stain. Hum Pathol, 25, 221-6. https://doi.org/10.1016/0046-8177(94)90191-0
- Matsukura N, Onda M, Tokunaga A, et al (1995). Detection of Helicobacter pylori DNA in gastric juice by the polymerase chain reaction: comparison with findings in bacterial culture and the detection of tissue IgA and serum IgG antibodies against Helicobacter pylori. J Gastroenterol, 30, 689-95. https://doi.org/10.1007/BF02349633
- Pandey R, Misra V, Misra SP, et al (2010). Helicobacter pylori and gastric cancer. Asian Pac J Cancer Prev, 11, 583-8.
- Slater B (1990). Superior stain for Helicobacter pylori using toluidine O. J Clin Pathol, 43, 961.
- Thijs JC, van Zwet AA, Thijs WJ, et al (1996). Diagnostic tests for Helicobacter pylori: a prospective evaluation of their accuracy, without selecting a single test as the gold standard. Am J Gastroenterol, 91, 2125-9.
- Tomtitchong P, Tiemtanom S, Eiumtrakul S, et al (1999). H. pylori infection and the correlation to chronic active gastritis detected by the histological division of the Sydney System. Siriraj Hosp Gaz, 51, 339-47.
- Uemura N, Okamoto S, Yamamoto S, et al (2001). Helicobacter pylori infection and the development of gastric cancer. N Engl J Med, 345, 784-9. https://doi.org/10.1056/NEJMoa001999
- Valentine JL, Arthur RR, Mobley HL, et al (1991). Detection of Helicobacter pylori by using the polymerase chain reaction. J Clin Microbiol, 29, 689-95.
- Wiwanitkit V (2010). Helicobacter pylori screening to prevent gastric cancer: an economical analysis for a tropical developing country. Asian Pac J Cancer Prev, 11, 571-2.
- Wright CL, Kelly JK (2006). The use of routine special stains for upper gastrointestinal biopsies. Am J Surg Pathol, 30, 357-61.
- Yali Z, Yamada N, Wen M, et al (1998). Gastrospirillum hominis and Helicobacter pylori infection in Thai individuals: comparison of histopathological changes of gastric mucosa. Pathol Int, 48, 507-11. https://doi.org/10.1111/j.1440-1827.1998.tb03941.x
- Yu XW, Xu Q, Xu Y, et al (2014). Expression of the E-cadherin/ beta-catenin/tcf-4 pathway in gastric diseases with relation to Helicobacter pylori infection: clinical and pathological implications. Asian Pac J Cancer Prev, 15, 215-20. https://doi.org/10.7314/APJCP.2014.15.1.215
- Zhang C, Yamada N, Wu YL, et al (2005a). Comparison of Helicobacter pylori infection and gastric mucosal histological features of gastric ulcer patients with chronic gastritis patients. World J Gastroenterol, 11, 976-81. https://doi.org/10.3748/wjg.v11.i7.976
- Zhang C, Yamada N, Wu YL, et al (2005b). Helicobacter pylori infection, glandular atrophy and intestinal metaplasia in superficial gastritis, gastric erosion, erosive gastritis, gastric ulcer and early gastric cancer. World J Gastroenterol, 11, 791-6. https://doi.org/10.3748/wjg.v11.i6.791
- Zhang Y, Lai Z, Wang J (2001). Helicobacter pylori associated gastric mucosal inflammation and histopathological assessment. Zhonghua Yi Xue Za Zhi, 81, 811-5 (in Chinese).
- Zullo A, Hassan C, Ridola L, et al (2014). Gastric MALT lymphoma: old and new insights. Ann Gastroenterol, 27, 27-33.
- Effect of Pretreatment with Lactobacillus delbrueckii and Streptococcus thermophillus on Tailored Triple Therapy for Helicobacter pylori Eradication: A Prospective Randomized Controlled Clinical Trial vol.16, pp.12, 2015, https://doi.org/10.7314/APJCP.2015.16.12.4885
- infection vol.20, pp.10834389, 2015, https://doi.org/10.1111/hel.12250
- Helicobacter pylori virulence genes of minor ethnic groups in North Thailand vol.9, pp.1, 2017, https://doi.org/10.1186/s13099-017-0205-x
- To Evaluate the Role of H. pylori in Patients with Chronic Recurrent Tonsillitis pp.0973-7707, 2018, https://doi.org/10.1007/s12070-018-1313-8
- Assessment of neurohepatic DNA damage in male Sprague–Dawley rats exposed to organophosphates and pyrethroid insecticides vol.25, pp.16, 2018, https://doi.org/10.1007/s11356-018-1776-x
- Pathological and hematological studies on the effect of curcumin on manganese chloride-induced neurotoxicity in rats vol.28, pp.1, 2019, https://doi.org/10.1007/s00580-018-02888-6