Cengiz KOCAK, Sirin KUCUK, Ersoy ERCİHAN, Mehmet GUNDOGAN, Canan SAKAR, Asli Ucar UNCU, Bulent MİZRAK

Does anti-Helicobacter pylori immunohistochemical staining has a confirmative role in the definitive diagnosis of negative gastric biopsy samples stained with routine histological stains?

Helicobacter pylori (H. pylori) causes chronic gastritis, and is associated with gastric lymphoma and carcinoma. Although severe infections with many bacteria can be identified easily on hematoxylin-eosin (H&E)–stained tissue samples; the identification ratio is only 66% with many false-positive and false-negative results. Furthermore, identification of the low-density bacteria, primarily following the therapy, requires special staining methods. The purpose of this study was to investigate whether the use of anti-helicobacter immunohistochemical (IHC) methods in the histopathological diagnosis of H. pylori is necessary to obtain accurate results. We investigated whether the use of specific immunohistochemical methods can detect H. pylori, which previously undetected by classical histological staining methods, in endoscopic gastric biopsy specimens. The study involved 210 endoscopic gastric biopsies considered as H. pylori negative with routine histological stainings and subsequently applied IHC staining methods to confirmative diagnosis. Inflammation was seen in all cases. One hundred thirty-eight patients had chronic inactive, 72 patients had chronic active gastritis. While H. pylori was found as negative in all cases with H&E and Giemsa stainings, in 60 of all these cases, H. pylori was found as positive with anti-H. pylori IHC staining. We suggest that in cases of chronic gastritis suggestive of H. pylori infection, when H. pylori cannot be seen by routine histological stainings, the IHC staining method is a definitive diagnostic tool for identification of H. pylori to avoid from false negative results.

PDF

___

Galiatsatos P, Wyse J, Szilagyi A. Accuracy of biopsies for helicobacter pylori in the presence of intestinal metaplasia of the stomach. Turk J Gastroenterol. 2014;25:19-23.

Forman D, Newell DG, Fullerton F, et al. Association between infection with helicobacter pylori and risk of gastric cancer: evidence from a prospective investigation. BMJ. 1991;302:1302-5.

Parsonnet J, Friedman GD, Vandersteen DP, et al. Helicobacter pylori infection and the risk of gastric carcinoma. N Engl J Med. 1991;325:1127-31.

International Agency for Research on Cancer. IARC monographs on the evaluation of the carcinogenic risks to humans. Schistosomes, liver flukes and Helicobacter pylori. Vol. 61. Lyon: International Agency for Research on Cancer; 1994. p. 177.

Barbosa AJA. Detection of H. pylori in endoscopic gastric biopsies: a routine research that goes far beyond the laboratory limits. J Bras Patol Med Lab. 2015;51:70-71.

Geller SA. Small organism, many challenges. Hum Pathol. 1996;27:1-4.

Eyzaguirre E, Haque AK. Application of immunohistochemistry to infections. Arch Pathol Lab Med. 2008;132:424-31.

Marzio L, Angelucci D, Grossi L, et al. Anti-Helicobacter pylori specific antibody immunohistochemistry improves the diagnostic accuracy of Helicobacter pylori in biopsy specimen from patients treated with triple therapy. Am J Gastroenterol. 1998;93:223-6.

Dixon MF, Genta RM, Yardley JH, et al. Classification and grading of gastritis. The updated Sydney System. International Workshop on the Histopathology of Gastritis, Houston 1994. Am J Surg Pathol. 1996;20:1161-1181.

10. Jonkers D, Stobberingh E, de Bruine A, et al. Stockbrügger R.Evaluation ofimmunohistochemistry for the detection of Helicobacter pyloriin gastric mucosal biopsies. J Infect. 1997;35:149-54.

11. Ashton-Key M, Diss TC, Isaacson PG. Detection of Helicobacter pylori in gastric biopsy and resection specimens. J Clin Pathol. 1996;49:107-11.

12. Yang Y, Xiong W, Wang S, et al. Factors associated with detection of helicobacter pylori in gastric biopsies: A case-control study of 396 Biopsies. Appl Immunohistochem Mol Morphol. 2018;26:345-50.

13. Batts KP, Ketover S, Kakar S, et al. Appropriate use of special stains for identifying Helicobacter pylori: Recommendations from the Rodger C. Haggitt Gastrointestinal Pathology Society. Am J Surg Pathol. 2013;37:e1222.

14. Smith SB, Snow AN, Perry RL, et al. Helicobacter pylori: to stain or not to stain? Am J Clin Pathol. 2012;137:733-8.

15. Cutler AF, Havstad S, Ma CK, et al. Accuracy of invasive and noninvasive tests to diagnose Helicobacter pylori infection. Gastroenterology. 1995;109:136-41.

16. Wang XI, Zhang S, Abreo F, et al. The role of routine immunohistochemistry for Helicobacter pylori in gastric biopsy. Ann Diagn Pathol. 2010;14:256-9.

17. Anim JT, Al-Sobkie N, Prasad A, et al. Assessment of different methods for staining Helicobacter pylori in endoscopic gastric biopsies. Acta Histochem. 2000;102:129-37.

18. Sepulveda AR, Patil M.Practical approach to the pathologic diagnosis of gastritis. Arch Pathol Lab Med. 2008;132:1586-93.

19. Tajalli R, Nobakht M, Mohammadi-Barzelighi H, et al. The immunohistochemistry and toluidine blue roles for Helicobacter pylori detection in patients with gastritis. Iran Biomed J. 2013;17: 36-41.

20. Goldstein NS. Chronic inactive gastritis and coccoid Helicobacter pylori in patients treated for gastroesophageal reflux disease or with H pylori eradication therapy. Am J Clin Pathol. 2002;118:719-26.

21. Patnayak R, Reddy V, Jena A, et al. Utility of immunohistochemistry in demonstrating Helicobacter pylori. Onc Gas Hep Rep. 2015;4:4-7.

22. Kuipers EJ, Uyterlinde AM, Peña AS, et al. Long-term sequelae of Helicobacter pylori gastritis. Lancet. 1995;345:1525-8.

23. Kuipers EJ, Klinkenberg-Knol EC, Vandenbroucke-Grauls CM, et al. Role of Helicobacter pylori in the pathogenesis of atrophic gastritis. Scand J Gastroenterol Suppl. 1997;223:28-34.

24. Annibale B, Negrini R, Caruana P, et al. Two-thirds of atrophic body gastritis patients have evidence of Helicobacter pylori infection. Helicobacter. 2001;6:225-33.

25. Oksanen A, Sipponen P, Karttunen R, et al. Atrophic gastritis and Helicobacter pylori infection in outpatients referred for gastroscopy. Gut. 2000;46:460-3.

26. Kuipers EJ. Helicobacter pylori and the risk and management of associated diseases: gastritis, ulcer disease, atrophic gastritis and gastric cancer. Aliment Pharmacol Ther. 1997;11 Suppl 1:71-88.

27. Ley C, Mohar A, Guarner J, et al. Helicobacter pylori eradication and gastric preneoplastic conditions: a randomized, double-blind, placebo-controlled trial. Cancer Epidemiol Biomarkers Prev. 2004;13:4-10.

28. Karnes WE Jr, Samloff IM, Siurala M, et al. Positive serum antibody and negativetissue staining for Helicobacter pyloriin subjects with atrophic body gastritis. Gastroenterology. 1991;101:167–74.

29. Lee JY, Kim N.Diagnosis of Helicobacter pylori by invasive test: histology. Ann Transl Med. 2015;3:10.

30. Kokkola A, Rautelin H, Puolakkainen P, et al. Diagnosis of Helicobacter pylori infection in patients with atrophic gastritis: comparison of histology, 13C-urea breath test, and serology. Scand J Gastroenterol. 2000;35:138-41.

31. Testoni PA, Bonassi U, Bagnolo F, et al. In diffuse atrophic gastritis, routine histology underestimates Helicobacter pylori infection. J Clin Gastroenterol. 2002;35:234-9.

32. Ohkuma K, Okada M, Murayama H, et al. Association of Helicobacter pylori infection with atrophic gastritis and intestinal metaplasia. J Gastroenterol Hepatol. 2000;15:1105-12.