Department of Paediatric Surgery, Emma Children's Hospital, Amsterdam UMC, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
Department of Gastroenterology and Hepatology, Amsterdam Gastroenterology and Metabolism, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands.
Virchows Arch. 2022 Aug;481(2):245-252. doi: 10.1007/s00428-022-03334-3. Epub 2022 May 5.
Rectal suction biopsy (RSB) is a gold standard for diagnosing Hirschsprung disease (HD). Calretinin staining of RSB is increasingly used by experienced pathologists due to non-complex examination and comparable diagnostic accuracy with acetylcholinesterase (AChE). However, the diagnostic accuracy of calretinin examined by unexperienced pathologists remains to be elucidated. Therefore, we aim to compare diagnostic accuracy of calretinin with AChE on RSB for diagnosing HD when examined by unexperienced pathologists. We prospectively analyzed sections from RSB stained with AChE + HE and calretinin. Blinded examination was done by five unexperienced pathologists (pathology residents) and three experienced pathologists (senior pediatric gastro-enterology pathologists) assessing for the presence of HD. Cases for the study included ones proven to be HD on resection specimens and cases without HD. Diagnostic accuracy was determined calculating area under the curve (AUC), sensitivity, specificity, likelihood ratio, and posttest probability. Fleiss' kappa analysis was performed to assess interobserver agreement between reviewers. Eleven of 18 included patients (61%) were diagnosed with HD. Comparing the diagnostic accuracy of unexperienced pathologists, calretinin versus AChE + HE showed sensitivity of 80.0% versus 74.5% and specificity of 100% versus 65.4%, AUC of 0.87 (0.78-0.96) versus 0.59 (0.45-0.72). Unexperienced pathologists showed substantial agreement with calretinin (kappa 0.72 [0.61-0.84]) and fair agreement with AChE + HE (kappa 0.34 [0.23-0.44]). We found calretinin having higher diagnostic accuracy in diagnosing HD compared to AChE + HE when examined by unexperienced pathologists. Therefore, we recommend to use calretinin as the standard technique for staining RSB in diagnosing HD.
直肠抽吸活检（RSB）是诊断先天性巨结肠症（HD）的金标准。由于检查不复杂且与乙酰胆碱酯酶（AChE）相比具有相当的诊断准确性，经验丰富的病理学家越来越多地使用钙结合蛋白染色法对 RSB 进行染色。然而，经验不足的病理学家检查钙结合蛋白的诊断准确性仍有待阐明。因此，我们旨在比较经验不足的病理学家检查钙结合蛋白与 AChE 对 RSB 进行 HD 诊断的诊断准确性。我们前瞻性地分析了用 AChE+HE 和钙结合蛋白染色的 RSB 切片。由五名经验不足的病理学家（病理住院医师）和三名经验丰富的病理学家（高级儿科胃肠病学病理学家）进行盲法检查，评估是否存在 HD。研究病例包括在切除标本中证实为 HD 的病例和无 HD 的病例。通过计算曲线下面积（AUC）、敏感性、特异性、似然比和后验概率来确定诊断准确性。采用 Fleiss'kappa 分析评估审核员之间的观察者间一致性。18 名纳入患者中有 11 名（61%）被诊断为 HD。比较经验不足的病理学家的诊断准确性，钙结合蛋白与 AChE+HE 的敏感性分别为 80.0%和 74.5%，特异性分别为 100%和 65.4%，AUC 分别为 0.87（0.78-0.96）和 0.59（0.45-0.72）。经验不足的病理学家与钙结合蛋白显示出高度一致性（kappa 值 0.72[0.61-0.84]），与 AChE+HE 显示出适度一致性（kappa 值 0.34[0.23-0.44]）。我们发现经验不足的病理学家检查钙结合蛋白诊断 HD 的准确性高于 AChE+HE，因此我们建议将钙结合蛋白作为诊断 HD 的 RSB 染色标准技术。
