From the Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Houston, Texas (Shehabeldin, Hussey, Truong).
The School of Public Health, Texas A&M University, College Station (Aggad). Shehabeldin is currently at the Pathology Department, MD Anderson Cancer Center, Houston, Texas.
Arch Pathol Lab Med. 2023 Aug 1;147(8):907-915. doi: 10.5858/arpa.2021-0512-OA.
CONTEXT.—: The tissue diagnosis of amyloidosis is traditionally suggested by hematoxylin-eosin stain and confirmed by Congo red stain, both examined by routine light microscopy. Both false-positive and false-negative congophilia are well documented, limiting the sensitivity and specificity of the Congo red stain for the diagnosis of amyloidosis. Examination of Congo red-stained tissue by Texas Red-filtered fluorescence microscopy (TRFM) is known to enhance the amyloid-specific congophilia, thus increasing the diagnostic sensitivity.
OBJECTIVE.—: To determine whether TRFM can mitigate the false positivity and thus improve the diagnostic specificity of the Congo red stain.
DESIGN.—: Ninety-two tissue samples were categorized into 3 groups. Group I included 15 samples with tissue deposition of amyloid. Group II consisted of 63 samples in which amorphous eosinophilic structures reminiscent of amyloid were seen on hematoxylin-eosin-stained tissue sections. Group III included 14 samples in which amyloid and amyloid-like tissue were seen side by side. The final diagnosis of presence or absence of amyloidosis in each case was established by clinicopathologic correlation. The congophilic areas in each case were identified by light microscopy. The same areas were then examined by TRFM.
RESULTS.—: TRFM enhanced congophilia, confirming the diagnosis of amyloidosis in all group I cases. Enhancement was not seen in 52 of the 63 group II cases. For group III cases, TRFM enhanced the amyloid-specific congophilia, but not the nonspecific congophilia, in all cases.
CONCLUSIONS.—: TRFM increases the diagnostic yield and specificity of Congo red-stained tissue sections for detection of amyloid.
淀粉样变性的组织诊断传统上通过苏木精-伊红染色和刚果红染色提示，并通过常规光学显微镜检查确认。刚果红染色的假阳性和假阴性均有充分记录，限制了刚果红染色对淀粉样变性诊断的敏感性和特异性。通过 Texas Red 滤光荧光显微镜（TRFM）检查刚果红染色的组织已知可增强淀粉样物质特异性的刚果红嗜染性，从而提高诊断敏感性。
确定 TRFM 是否可以减轻假阳性，从而提高刚果红染色的诊断特异性。
92 个组织样本分为 3 组。第 1 组包括 15 个有淀粉样物质沉积的样本。第 2 组包括 63 个在苏木精-伊红染色的组织切片上看到无定形嗜酸性结构，类似于淀粉样物质的样本。第 3 组包括 14 个同时存在淀粉样物质和类似淀粉样物质的样本。每个病例的淀粉样变性的存在或不存在的最终诊断是通过临床病理相关性建立的。每个病例的刚果红嗜染区通过光学显微镜识别。然后用 TRFM 检查相同区域。
TRFM 增强了刚果红嗜染性，确认了所有第 1 组病例的淀粉样变性诊断。在 63 例第 2 组病例中，有 52 例未观察到增强。对于第 3 组病例，TRFM 增强了所有病例的淀粉样物质特异性刚果红嗜染性，但非特异性刚果红嗜染性没有增强。
TRFM 增加了刚果红染色组织切片检测淀粉样物质的诊断收益和特异性。
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