Gonzalez Abel Arnoldo, Hamele-Bena Diane, Wood Teresa, Valladares-Silva Sunilda, Wasserman Patricia G
Department of Clinical Pathology & Cell Biology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York.
Department of Clinical Pathology & Cell Biology, Columbia University Medical Center, New York Presbyterian Hospital, New York, New York.
J Am Soc Cytopathol. 2017 Nov-Dec;6(6):242-247. doi: 10.1016/j.jasc.2017.06.207. Epub 2017 Jul 6.
Current approaches to Pneumocystis jirovecii (PCJ) screening on bronchioalveolar lavage samples (BAL) include Gomori/Grocott methenamine silver stain (GMS), toluidine blue O stain, Wright-Giemsa stain, immunofluorescent antibody stain, and polymerase chain reaction. Another method available is PCJ immunohistochemistry stain (PCJ IHC). There are no published series evaluating the efficacy of PCJ IHC in cell block preparation of BAL, we sought to compare GMS versus PCJ IHC at our institution.
We performed a retrospective analysis at our institution of all BAL with cell blocks where PCJ IHC and GMS were done simultaneously since March 2015.
982 BAL samples were identified from 640 patients (median age: 54 years; range: 1-84 years). For 895 cases, GMS and PCJ IHC were performed simultaneously. PCJ was identified in 14 samples, from 13 patients (2.2% of patients) using PCJ IHC. GMS stains were read as positive in only 6 of these 14 cases (42.8%); in two of those cases, PCJ was easily identified on routine Papanicolaou stains. We repeated GMS staining on those 14 cases following before-schedule maintenance in our Ventana Benchmark Autostainer, identifying 12 cases positive. In addition, a significantly higher number of organisms was seen on repeat GMS (median: 58) than the original GMS (median: 8.7). Nevertheless, a statistically significant higher number of organisms was detected by PCJ IHC (median: 474).
PCJ IHC performed in cell block is more sensitive and specific than GMS and is a reliable marker when a low number of PCJ organisms are present.
目前对支气管肺泡灌洗样本（BAL）进行耶氏肺孢子菌（PCJ）筛查的方法包括戈莫里/格罗科特甲胺银染色（GMS）、甲苯胺蓝O染色、瑞氏-吉姆萨染色、免疫荧光抗体染色和聚合酶链反应。另一种可用的方法是PCJ免疫组织化学染色（PCJ IHC）。目前尚无已发表的系列研究评估PCJ IHC在BAL细胞块制备中的效果，我们试图在我们机构比较GMS和PCJ IHC。
我们对自2015年3月以来在我们机构同时进行PCJ IHC和GMS检测的所有BAL细胞块进行了回顾性分析。
从640例患者（中位年龄：54岁；范围：1 - 84岁）中鉴定出982份BAL样本。对于895例病例，同时进行了GMS和PCJ IHC检测。使用PCJ IHC在14份样本中鉴定出PCJ，来自13例患者（占患者的2.2%）。在这14例病例中，GMS染色仅在6例中被判定为阳性（42.8%）；其中2例在常规巴氏染色中可轻松鉴定出PCJ。在我们的Ventana Benchmark自动染色仪提前进行维护后，我们对这14例病例重复进行了GMS染色，鉴定出12例阳性。此外，重复GMS染色时观察到的病原体数量（中位数：58）明显高于原始GMS（中位数：8.7）。然而，PCJ IHC检测到的病原体数量在统计学上显著更高（中位数：474）。
在细胞块中进行的PCJ IHC比GMS更敏感和特异，并且在PCJ病原体数量较少时是一种可靠的标志物。
