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。

IF 3.1 3区 医学 Q1 PATHOLOGY
Anna Hochner-Ger, Liat Anafi, Ido Veisman, Iris Barshack, Chen Mayer
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引用次数: 0

摘要

巨细胞病毒(CMV)是免疫功能低下个体的主要病原体,常引起严重的胃肠道并发症。免疫组织化学(IHC)由于其高特异性而被广泛用于CMV检测,但其在CMV阳性细胞稀少的情况下的可靠性仍不确定。本研究通过评估连续切片的巨细胞病毒检测来评估胃肠道活检中巨细胞病毒免疫组化的可重复性。一项前瞻性观察研究于2023年至2024年在示巴医学中心病理研究所进行。纳入25例基于免疫组化诊断的CMV结肠炎病例,并将其分类为阳性(≥2个CMV阳性细胞)或模棱两可(1个CMV阳性细胞)。对组织块进行连续切片和随后的CMV免疫组化染色。描述性统计分析,包括Friedman检验和Wilcoxon符号秩检验,用于评估CMV检测的变异性。cmv阳性细胞计数在连续切片中差异显著(p = 0.047, Friedman检验)。虽然有些病例保持稳定,但其他病例波动,从阳性过渡到模棱两可或阴性。在最初阳性的病例中,33.3%(7/21)至少有一个阴性切片,33.3%(7/21)至少有一个模糊切片。模棱两可的病例高度不稳定,所有病例至少显示一个阴性部分,一个转化为阳性。两两Wilcoxon检验显示没有一致的显著差异。CMV IHC在低阳性病例中表现出可变性,导致诊断转变。连续切片提高了可信度,但不能完全消除可变性。将免疫组化与分子方法相结合的多模式方法以及免疫组化方案的进一步标准化可能会提高巨细胞病毒检测的准确性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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.

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来源期刊
Virchows Archiv
Virchows Archiv 医学-病理学
CiteScore
7.40
自引率
2.90%
发文量
204
审稿时长
4-8 weeks
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.
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