Department of Gastroenterology and Hepatology, TaoYuan General Hospital, Taiwan.
Ann Diagn Pathol. 2013 Feb;17(1):63-6. doi: 10.1016/j.anndiagpath.2012.06.004. Epub 2012 Sep 13.
Biopsy of ulcer margin is routinely performed to exclude malignancy in patients with gastric ulcers, but its utility in diagnosing Helicobacter pylori infection has not yet been fully studied. A cohort of 50 patients with gastric ulcer was prospectively examined. Three tests including histology, rapid urease test, and urea breath test were performed in all patients for diagnosing H pylori infection. Six biopsied specimens from the margin of the gastric ulcer and 1 each specimen from antrum and body of non-ulcer part were obtained for histology using hematoxylin-eosin (H&E) stain. The criterion used for defining H pylori infection was a positive result in at least 2 of the 3 tests. H pylori infection was diagnosed in 27 (54%) of the patients. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the histological examination of the ulcer margin were 92.6%, 95.7%, 96.2%, 91.7%, and 94%, respectively. The addition of 1 specimen from the antrum or body or a combination of the 2 specimens did not increase the diagnostic yields of those for histological examination of ulcer margin alone. The diagnostic sensitivity, specificity, positive predictive value, negative predictive value, and accuracy for the rapid urease test were 96.3%, 100%, 100%, 95.8%, and 98%, respectively, and the corresponding values for the urea breath test were 88.9%, 87%, 88.9%, 87%, and 88%. We performed Giemsa stain for the 3 patients with false-negative and false-positive results of histological examination of ulcer margin using H&E stain, and all were positive for H pylori infection. In conclusion, histological examination of the ulcer margin using hematoxylin-eosin stain was quite accurate and useful for diagnosing H pylori infection in patients with gastric ulcers. A special stain is required when the diagnosis of H pylori infection is questionable on routine H&E staining.
对胃溃疡患者的溃疡边缘进行活检以排除恶性肿瘤是常规操作，但尚未充分研究其在诊断幽门螺杆菌感染方面的效用。对 50 例胃溃疡患者进行前瞻性检查。所有患者均进行组织学、快速尿素酶试验和尿素呼气试验三项检测以诊断 H pylori 感染。从胃溃疡边缘获得 6 个活检标本，从非溃疡部分的胃窦和体部各获得 1 个标本，用苏木精-伊红（H&E）染色进行组织学检查。定义 H pylori 感染的标准是 3 项检测中至少有 2 项呈阳性。27 例（54%）患者诊断为 H pylori 感染。组织学检查胃边缘的诊断敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 92.6%、95.7%、96.2%、91.7%和 94%。单独检查溃疡边缘组织学增加 1 个胃窦或胃体标本或两者组合并没有增加这些标本的诊断率。快速尿素酶试验的诊断敏感性、特异性、阳性预测值、阴性预测值和准确性分别为 96.3%、100%、100%、95.8%和 98%，尿素呼气试验的相应值分别为 88.9%、87%、88.9%、87%和 88%。我们对 3 例 H&E 染色组织学检查胃边缘呈假阴性和假阳性的患者进行了吉姆萨染色，所有患者均呈 H pylori 感染阳性。总之，用苏木精-伊红染色进行溃疡边缘组织学检查对于诊断胃溃疡患者的 H pylori 感染非常准确且有用。当常规 H&E 染色对 H pylori 感染的诊断有疑问时，需要进行特殊染色。
