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The efficacy of the improved zirconyl hematoxylin in the diagnosis of Barrett’…


Biology Articles » Methods & Techniques » Use of an improved zirconyl hematoxylin stain in the diagnosis of Barrett’s esophagus » Introduction

Introduction
- Use of an improved zirconyl hematoxylin stain in the diagnosis of Barrett’s esophagus

Barrett’s esophagus is one of the more serious consequences of gastroesophageal reflux disease. Barrett’s esophagus originally referred to any columnar metaplasia of the esophageal epithelium [1, 2]. Since 1998, the diagnosis of Barrett’s esophagus has been restricted to an intestinal metaplasia of the esophagus in which goblet cells are present [3]. Because this intestinal metaplasia has a 10% risk of progressing to adenocarcinoma of the esophagus [3, 4], accurate diagnosis is essential. While endoscopy may create a strong suspicion of the presence of intestinal metaplasia, definitive diagnosis requires microscopic identification of goblet cells in the esophageal epithelium [5–7]. Although goblet cells can be identified in H&E sections, diagnostic accuracy is improved by staining the acidic mucins of the goblet cells with alcian blue [8, 9]. Even studies that have concluded that special staining of the acidic mucins is not always necessary for the diagnosis of Barrett’s esophagus have admitted that it is sometimes necessary [7].

The supply of alcian blue has been erratic. The quality of some lots of alcian blue has been unacceptable for histological purposes [10, 11, 12]. Periodically, alcian blue has disappeared from the market altogether [13, 14]. Colloidal iron can be used as a substitute for alcian blue [15], but the working solution is short-lived [15, 16]. Preparing a good stock solution of colloidal iron is time-consuming [17, 18]. Workers who recommend quick procedures for preparing the stock solution often report erratic staining results [19, 20]. This has also been the authors’ experience.

Zirconyl hematoxylin also stains acidic mucins [21, 22]. While the staining intensity of the original formulation is adequate for aiding in the diagnosis of adenocarcinoma of the prostate [22], it is too pale for rapid screening of esophageal biopsies. A recent improvement in the formulation of zirconyl hematoxylin [14] markedly increases the intensity of the stain. The efficacy of the improved zirconyl hematoxylin in the diagnosis of Barrett’s esophagus was tested and compared to the efficacy of alcian blue.


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