Sen Sait, Sarsik Kumbaraci Banu
Department of Medical Pathology, Ege University, Faculty of Medicine, İzmir, Turkey.
Turk Patoloji Derg. 2012;28(3):204-12. doi: 10.5146/tjpath.2012.01126.
Systemic amyloidosis is a rare disorder, characterized by extracellular accumulation of Congo red positive fibrillar amyloid protein deposits that have an amorphous, eosinophilic appearance on hematoxylin-eosin stained preparations. The kidney is the most commonly affected organ by systemic amyloidosis. Congo red staining increases the positive birefringence of the weakly birefringent unstained amyloid. In this study, we investigated the potential diagnostic power of digitally reinforced birefringence of routine hematoxylin-eosin stained slides from renal biopsies.
We reviewed 130 hematoxylin-eosin stained slides for polarization. Sixty-five new amyloidosis cases were diagnosed by renal biopsy. All renal biopsies were evaluated by light microscopy and immunofluorescence. Slides were reevaluated blindly using a microscope (Olympus BX51) that was attached polarization filters and connected to a digital camera (Olympus DP21, SAL). Deposits that showed green birefringence on hematoxylin-eosin preparations with digitalized microscopy were considered positive and the results were confirmed using Congo red.
Of the 65 Congo red confirmed amyloid positive biopsies, 61 showed green birefringence with hematoxylin-eosin. Of the 65 Congo-red confirmed amyloid negative biopsies, two were considered to be false positive. The sensitivity, specificity, and positive and negative predictive values were estimated as 94%, 97%, 97% and 94% respectively.
We concluded that polarized hematoxylin-eosin sections can be used digitally as a fast and first step diagnostic method for renal amyloidosis.
系统性淀粉样变性是一种罕见疾病，其特征为刚果红阳性纤维状淀粉样蛋白沉积物在细胞外积聚，在苏木精-伊红染色制剂上呈无定形、嗜酸性外观。肾脏是系统性淀粉样变性最常受累的器官。刚果红染色可增加未染色的弱双折射淀粉样蛋白的正双折射。在本研究中，我们调查了肾活检常规苏木精-伊红染色玻片数字增强双折射的潜在诊断能力。
我们回顾了130张用于偏振检查的苏木精-伊红染色玻片。通过肾活检诊断出65例新的淀粉样变性病例。所有肾活检均通过光学显微镜和免疫荧光进行评估。使用配备偏振滤光片并连接数码相机（Olympus DP21，SAL）的显微镜（Olympus BX51）对玻片进行盲法重新评估。在数字化显微镜下苏木精-伊红制剂上显示绿色双折射的沉积物被视为阳性，并使用刚果红进行结果确认。
在65例经刚果红证实为淀粉样蛋白阳性的活检病例中，61例在苏木精-伊红染色下显示绿色双折射。在65例经刚果红证实为淀粉样蛋白阴性的活检病例中，有2例被认为是假阳性。敏感性、特异性、阳性预测值和阴性预测值分别估计为94%、97%、97%和94%。
我们得出结论，偏振苏木精-伊红切片可数字化用作肾淀粉样变性的快速初步诊断方法。
