Assessing the diagnostic accuracy of routine hematoxylin and eosin, Alcian Blue/Periodic Acid-Schiff, and Giemsa stains in the detection of Helicobacter pylori in gastric biopsies.

BACKGROUND

Hematoxylin and Eosin (H&E), Alcian Blue/Periodic Acid-Schiff (AB/PAS), and Giemsa stains are routinely used in the histopathological evaluation of gastric biopsies. However, comparative data on their diagnostic performance and cost-effectiveness in detecting Helicobacter pylori are limited. This study aimed to assess the feasibility of using H&E and AB/PAS as alternatives to Giemsa.

METHODS

A retrospective study was conducted on 816 gastric biopsy cases collected between 2019 and 2021. Three slides (H&E, Giemsa, and AB/PAS) were previously prepared from each paraffin-embedded tissue sample and blindly evaluated by three independent examiners. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated using 2×2 contingency tables.

RESULTS

>H&E yielded a sensitivity of 51.6%, specificity of 74.4%, and diagnostic accuracy of 66.4% when compared to Giemsa as the reference standard. In comparison, AB/PAS exhibited a sensitivity of 45.9%, specificity of 73.2%, and an accuracy of 63.7%. When evaluating operational factors, H&E emerged as the most cost-effective and fastest method, while AB/PAS was associated with higher costs and longer processing times. Overall, Giemsa consistently demonstrated superior diagnostic performance across the assessed metrics, positioning it as the more reliable choice for H. pylori detection within this comparative framework.

CONCLUSIONS

H&E shows potential for initial screening but its limited sensitivity prevents definitive diagnosis. AB/PAS proved less effective and economical. Giemsa maintained superior diagnostic performance. This study provides a comparative methodological assessment, suggesting H&E and Giemsa combinations could enhance detection efficiency and accuracy. Further prospective validation is needed before clinical implementation.