Johnson Dennis R, Abdelbaqui Maisoun, Tahmasbi Maryam, Mayer Zoltan, Lee Hung-Wei, Malafa Mokenge P, Coppola Domenico
Dennis R Johnson, Maisoun Abdelbaqui, Maryam Tahmasbi, Domenico Coppola, Department of Anatomic Pathology, Moffitt Cancer Center and Research Institute, Tampa, FL 33612, United States.
World J Gastroenterol. 2015 Mar 7;21(9):2770-6. doi: 10.3748/wjg.v21.i9.2770.
To compare the sensitivity and specificity of CDX2 and alcian blue (AB) pH 2.5 staining in identifying esophageal intestinal metaplasia.
One hundred and ninty-nine biopsies from 186 patients were retrospectively reviewed and categorized as Barrett's esophagus (BE) (n = 108); non-Barrett's esophagus (NBE) (n = 48); columnar blue cells (CB) and esophageal glands (EG) (n = 43). The biopsies were stained with AB and immunostained for CDX2 using a mouse monoclonal antibody from Biogenex (clone CDX2-88) and the Ventana Discovery X automated immunostainer. The positive and negative predictive value of each group was used to determine the predictive power of CDX2 and AB in diagnosing intestinal metaplasia.
All of the 108 BE biopsies (100%) were positive for AB and 102 of them (94.4%) were positive for CDX2. The six BE patients (5.6%) who failed to stain with CDX2 were found to have lost the focus of intestinal metaplasia upon deeper sectioning for immunostaining. Both AB and CDX2 were negative in 43 out of 48 (89.6%) NBE cases. Five NBE patients (10.4%) were falsely positive for AB due to the presence of EG and CB in these biopsies. These cases were all CDX2 negative. In addition, 5 AB negative NBE were found to be CDX2 positive. Based on these results the CDX2 immunostain had similar sensitivity but higher specificity (100% vs about 91%) than AB in detecting intestinal type metaplasia in these samples. Our data shows that CDX2 has a better PPV in detecting intestinal metaplasia as compared to AB (95.6% vs 71.5%, respectively).
CDX2 has a better positive predictive value than AB in detecting intestinal metaplasia. CDX2 may be useful when challenged by gastro-esophageal biopsies containing mimikers of BE.
比较CDX2和pH 2.5阿尔辛蓝（AB）染色在识别食管肠化生中的敏感性和特异性。
回顾性分析186例患者的199份活检标本，分为巴雷特食管（BE）（n = 108）；非巴雷特食管（NBE）（n = 48）；柱状蓝色细胞（CB）和食管腺（EG）（n = 43）。活检标本用AB染色，并用来自Biogenex的小鼠单克隆抗体（克隆CDX2 - 88）和Ventana Discovery X自动免疫染色仪对CDX2进行免疫染色。每组的阳性和阴性预测值用于确定CDX2和AB在诊断肠化生中的预测能力。
108份BE活检标本全部（100%）AB染色阳性，其中102份（94.4%）CDX2染色阳性。6例（5.6%）BE患者CDX2染色未着色，经更深切片进行免疫染色后发现肠化生灶消失。48例NBE病例中有43例（89.6%）AB和CDX2均为阴性。5例（10.4%）NBE患者因活检标本中存在EG和CB而AB染色假阳性，这些病例CDX2均为阴性。此外，发现5例AB阴性的NBE患者CDX2阳性。基于这些结果，在检测这些样本中的肠化生时，CDX2免疫染色的敏感性相似，但特异性更高（分别为100%和约91%）。我们的数据表明，与AB相比，CDX2在检测肠化生方面具有更好的阳性预测值（分别为95.6%和71.5%）。
在检测肠化生方面，CDX2的阳性预测值优于AB。当遇到含有BE模仿物的胃食管活检标本时，CDX2可能有用。
