Routine Immunohistochemistry for H. pylori in Gastric Biopsy Is Neither Cost Effective nor Necessary
XI Wang, S Zhang, J Thomas, F Abreo. LSUHSC, Shreveport, LA
Background: H. pylori infection associates with gastritis, gastric ulcer, gastric adenocarcinoma, and mucosal associated lymphoid tissue (MALT) lymphoma. Documenting the presence of H. pylori in a gastric biopsy is essential for appropriate patient care. Several special stains and immunohistochemistry (IHC) testing methods are routinely used for the evaluation of gastric Hpylori. Our laboratory introduced routine IHC for H. pylori about a year ago, and this study aims to investigate the value of this protocol.
Design: Gastric biopsy cases were retrieved from department database during a year period (July 2008 to June 2009) after using routine IHC for H. pylori. Cases with diagnosis of carcinomas and lymphomas were excluded. For calculating the sensitivity and specificity of H&E examination, 40 cases (20 positive and 20 negative) were blindly reviewed by a pathology resident (XW), a junior faculty (SZ), a senior faculty (FA) and a GI pathologist (JOT) independently.
Results: A total of 224 patients qualified for the study criteria during this period. The diagnoses were chronic active gastritis (68), chronic gastritis (76), no pathologic abnormality (50), reactive gastropathy (24), and polyps (6). Fifty-four cases were positive for H. pylori on IHC, including 50 cases of chronic active gastritis and 4 cases of chronic gastritis. The IHC positive rate was 73.5% (50/68) in chronic active gastritis, 5.3% (4/76) in chronic gastritis, and 0% (0/80) in other diagnoses. The sensitivity/specificity of finding H. pylori by blindly reviewing H&E slides was 100%/100% for resident, 100%/100% for the junior faculty, 95 %/100% for the senior faculty, and 100%/100% for the GI pathologist.
Conclusions: Many gastric biopsies (35.7%, 80/224) in our group had no pathologic abnormality or reactive gastropathy, and did not need a routine IHC for H. pylori. Majority (92.6%, 50/54) IHC H. pylori positive cases were chronic active gastritis, and H. pylori organisms were easily identified on H&E slides due to the presence of numerous organisms. Few chronic gastritis cases (5.3%, 4/76) had H. pylori. H&E slide review had a very good sensitivity and specificity with all levels of observers. In summary, IHC for H. pylori should not be routinely used, especially during this economically challenging times. IHC should be reserved for unexplained gastritis and previous treated patients with low density of H. pylori organisms.
Monday, March 22, 2010 11:30 AM
Platform Session: Section E, Monday Morning