Anna Hochner-Ger, Liat Anafi, Ido Veisman, Iris Barshack, Chen Mayer
{"title":"超越第一次切割:评估CMV免疫组化可靠性在连续胃肠道活检切片。","authors":"Anna Hochner-Ger, Liat Anafi, Ido Veisman, Iris Barshack, Chen Mayer","doi":"10.1007/s00428-025-04226-y","DOIUrl":null,"url":null,"abstract":"<p><p>Cytomegalovirus(CMV) is a major pathogen in immunocompromised individuals, often causing severe gastrointestinal complications. Immunohistochemistry (IHC) is widely used for CMV detection due to its high specificity, but its reliability in cases with sparse CMV-positive cells remains uncertain. This study evaluates the reproducibility of CMV IHC in gastrointestinal biopsies by assessing CMV detection across serial sections. A prospective observational study was conducted at the Pathology Institute of Sheba Medical Center between the years 2023 and 2024. Twenty-five CMV colitis cases diagnosed based on IHC were included and categorized as positive (≥ 2 CMV-positive cells) or equivocal (1 CMV-positive cell). Serial sectioning of the tissue blocks and subsequent CMV IHC staining was performed. Descriptive statistical analysis, including the Friedman test and Wilcoxon signed-rank test, was used to assess variability in CMV detection. CMV-positive cell counts varied significantly across serial sections (p = 0.047, Friedman test). While some cases remained stable, others fluctuated, transitioning from positive to equivocal or negative. Among initially positive cases, 33.3% (7/21) had at least one negative section, and 33.3% (7/21) had at least one equivocal section. Equivocal cases were highly unstable, with all showing at least one negative section and one converting to positive. Pairwise Wilcoxon tests showed no consistent significant differences. CMV IHC exhibits variability in low-positive cases, leading to diagnostic transitions. Serial sectioning enhances confidence but does not fully eliminate variability. A multimodal approach integrating IHC with molecular methods and further standardization of IHC protocols may improve CMV detection accuracy.</p>","PeriodicalId":23514,"journal":{"name":"Virchows Archiv","volume":" ","pages":""},"PeriodicalIF":3.1000,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Beyond the first cut: evaluating CMV IHC reliability in serial gastrointestinal biopsy sections.\",\"authors\":\"Anna Hochner-Ger, Liat Anafi, Ido Veisman, Iris Barshack, Chen Mayer\",\"doi\":\"10.1007/s00428-025-04226-y\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Cytomegalovirus(CMV) is a major pathogen in immunocompromised individuals, often causing severe gastrointestinal complications. Immunohistochemistry (IHC) is widely used for CMV detection due to its high specificity, but its reliability in cases with sparse CMV-positive cells remains uncertain. This study evaluates the reproducibility of CMV IHC in gastrointestinal biopsies by assessing CMV detection across serial sections. A prospective observational study was conducted at the Pathology Institute of Sheba Medical Center between the years 2023 and 2024. Twenty-five CMV colitis cases diagnosed based on IHC were included and categorized as positive (≥ 2 CMV-positive cells) or equivocal (1 CMV-positive cell). Serial sectioning of the tissue blocks and subsequent CMV IHC staining was performed. Descriptive statistical analysis, including the Friedman test and Wilcoxon signed-rank test, was used to assess variability in CMV detection. CMV-positive cell counts varied significantly across serial sections (p = 0.047, Friedman test). While some cases remained stable, others fluctuated, transitioning from positive to equivocal or negative. Among initially positive cases, 33.3% (7/21) had at least one negative section, and 33.3% (7/21) had at least one equivocal section. Equivocal cases were highly unstable, with all showing at least one negative section and one converting to positive. Pairwise Wilcoxon tests showed no consistent significant differences. CMV IHC exhibits variability in low-positive cases, leading to diagnostic transitions. Serial sectioning enhances confidence but does not fully eliminate variability. A multimodal approach integrating IHC with molecular methods and further standardization of IHC protocols may improve CMV detection accuracy.</p>\",\"PeriodicalId\":23514,\"journal\":{\"name\":\"Virchows Archiv\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":3.1000,\"publicationDate\":\"2025-09-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Virchows Archiv\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00428-025-04226-y\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"PATHOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Virchows Archiv","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00428-025-04226-y","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"PATHOLOGY","Score":null,"Total":0}
Beyond the first cut: evaluating CMV IHC reliability in serial gastrointestinal biopsy sections.
Cytomegalovirus(CMV) is a major pathogen in immunocompromised individuals, often causing severe gastrointestinal complications. Immunohistochemistry (IHC) is widely used for CMV detection due to its high specificity, but its reliability in cases with sparse CMV-positive cells remains uncertain. This study evaluates the reproducibility of CMV IHC in gastrointestinal biopsies by assessing CMV detection across serial sections. A prospective observational study was conducted at the Pathology Institute of Sheba Medical Center between the years 2023 and 2024. Twenty-five CMV colitis cases diagnosed based on IHC were included and categorized as positive (≥ 2 CMV-positive cells) or equivocal (1 CMV-positive cell). Serial sectioning of the tissue blocks and subsequent CMV IHC staining was performed. Descriptive statistical analysis, including the Friedman test and Wilcoxon signed-rank test, was used to assess variability in CMV detection. CMV-positive cell counts varied significantly across serial sections (p = 0.047, Friedman test). While some cases remained stable, others fluctuated, transitioning from positive to equivocal or negative. Among initially positive cases, 33.3% (7/21) had at least one negative section, and 33.3% (7/21) had at least one equivocal section. Equivocal cases were highly unstable, with all showing at least one negative section and one converting to positive. Pairwise Wilcoxon tests showed no consistent significant differences. CMV IHC exhibits variability in low-positive cases, leading to diagnostic transitions. Serial sectioning enhances confidence but does not fully eliminate variability. A multimodal approach integrating IHC with molecular methods and further standardization of IHC protocols may improve CMV detection accuracy.
期刊介绍:
Manuscripts of original studies reinforcing the evidence base of modern diagnostic pathology, using immunocytochemical, molecular and ultrastructural techniques, will be welcomed. In addition, papers on critical evaluation of diagnostic criteria but also broadsheets and guidelines with a solid evidence base will be considered. Consideration will also be given to reports of work in other fields relevant to the understanding of human pathology as well as manuscripts on the application of new methods and techniques in pathology. Submission of purely experimental articles is discouraged but manuscripts on experimental work applicable to diagnostic pathology are welcomed. Biomarker studies are welcomed but need to abide by strict rules (e.g. REMARK) of adequate sample size and relevant marker choice. Single marker studies on limited patient series without validated application will as a rule not be considered. Case reports will only be considered when they provide substantial new information with an impact on understanding disease or diagnostic practice.