{"title":"Improving diagnostic clarity in fibro-osseous lesions using modified Gallego's, alizarin red, and von kossa stains: A pilot comparative study.","authors":"Sharon Sam, Vijaya Nirmala Subramani, Anand Ramanathan, Thamizhchelvan Harikrishnan","doi":"10.4103/jomfp.jomfp_11_26","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Distinguishing bone, cementum, and immature osteoid in maxillofacial fibro-osseous lesions (FOLs) can be challenging using routine haematoxylin and eosin (H&E) staining alone.</p><p><strong>Objective: </strong>To quantitatively evaluate the comparative diagnostic utility of H&E, Alizarin Red, Von Kossa, and Modified Gallego's stains (MGS) in identifying mineralized components across FOL subtypes.</p><p><strong>Materials and methods: </strong>In this pilot study, archival specimens of fibrous dysplasia (<i>n</i> = 2), cemento-osseous dysplasia (<i>n</i> = 2), cemento-ossifying fibroma (<i>n</i> = 2), and juvenile ossifying fibromas (<i>n</i> = 2) were stained. Independent pathologists scored structural feature visibility utilizing a semi-quantitative 0-3 scale. Visibility scores, inter-observer, and intra-observer reliability were analysed using Friedman, Wilcoxon signed-rank, and Gwet's AC1 tests.</p><p><strong>Results: </strong>Qualitatively, MGS provided consistent bone (green) versus cementum (red) differentiation, Alizarin Red isolated immature osteoid, and Von Kossa mapped mature, phosphate-rich calcifications. Quantitatively, inter-observer reliability demonstrated strong to perfect consensus, while intra-observer stability was moderate-to-perfect for MGS, slight-to-substantial for Alizarin Red, and poor-to-moderate for Von Kossa. Descriptively, MGS achieved the highest mean clarity score (2.93 ± 0.25), followed closely by Alizarin Red (2.80 ± 0.40) and Von Kossa (1.80 ± 1.17). Global Friedman and post-hoc pairwise comparisons confirmed that these differences were statistically significant (<i>P</i> = 0.0003), with both MGS (<i>P</i> = 0.0069) and Alizarin Red (<i>P</i> = 0.0057) yielding significantly superior diagnostic clarity over Von Kossa (<i>P</i> < 0.01).</p><p><strong>Conclusion: </strong>Integrating a targeted special stain selection protocol significantly overcomes the descriptive limitations of routine H&E, reducing diagnostic ambiguity in maxillofacial FOL configurations.</p>","PeriodicalId":38846,"journal":{"name":"Journal of Oral and Maxillofacial Pathology","volume":"30 2","pages":"303-311"},"PeriodicalIF":0.0000,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13450932/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Oral and Maxillofacial Pathology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.4103/jomfp.jomfp_11_26","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/7/3 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Distinguishing bone, cementum, and immature osteoid in maxillofacial fibro-osseous lesions (FOLs) can be challenging using routine haematoxylin and eosin (H&E) staining alone.
Objective: To quantitatively evaluate the comparative diagnostic utility of H&E, Alizarin Red, Von Kossa, and Modified Gallego's stains (MGS) in identifying mineralized components across FOL subtypes.
Materials and methods: In this pilot study, archival specimens of fibrous dysplasia (n = 2), cemento-osseous dysplasia (n = 2), cemento-ossifying fibroma (n = 2), and juvenile ossifying fibromas (n = 2) were stained. Independent pathologists scored structural feature visibility utilizing a semi-quantitative 0-3 scale. Visibility scores, inter-observer, and intra-observer reliability were analysed using Friedman, Wilcoxon signed-rank, and Gwet's AC1 tests.
Results: Qualitatively, MGS provided consistent bone (green) versus cementum (red) differentiation, Alizarin Red isolated immature osteoid, and Von Kossa mapped mature, phosphate-rich calcifications. Quantitatively, inter-observer reliability demonstrated strong to perfect consensus, while intra-observer stability was moderate-to-perfect for MGS, slight-to-substantial for Alizarin Red, and poor-to-moderate for Von Kossa. Descriptively, MGS achieved the highest mean clarity score (2.93 ± 0.25), followed closely by Alizarin Red (2.80 ± 0.40) and Von Kossa (1.80 ± 1.17). Global Friedman and post-hoc pairwise comparisons confirmed that these differences were statistically significant (P = 0.0003), with both MGS (P = 0.0069) and Alizarin Red (P = 0.0057) yielding significantly superior diagnostic clarity over Von Kossa (P < 0.01).
Conclusion: Integrating a targeted special stain selection protocol significantly overcomes the descriptive limitations of routine H&E, reducing diagnostic ambiguity in maxillofacial FOL configurations.
期刊介绍：
The journal of Oral and Maxillofacial Pathology [ISSN:print-(0973-029X, online-1998-393X)] is a tri-annual journal published on behalf of “The Indian Association of Oral and Maxillofacial Pathologists” (IAOMP). The publication of JOMFP was started in the year 1993. The journal publishes papers on a wide spectrum of topics associated with the scope of Oral and Maxillofacial Pathology, also, ensuring scientific merit and quality. It is a comprehensive reading material for the professionals who want to upgrade their diagnostic skills in Oral Diseases; allows exposure to newer topics and methods of research in the Oral-facial Tissues and Pathology. New features allow an open minded thinking and approach to various pathologies. It also encourages authors to showcase quality work done by them and to compile relevant cases which are diagnostically challenging. The Journal takes pride in maintaining the quality of articles and photomicrographs.
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