Chromoendoscopy with hematoxylin in the classificaton of gastric lesions

Background. Hematoxylin is a basic histological stain which stains nuclei. Apparently, it can be used with endoscopy to diagnose malignant lesions due to their increased nucleus-to-cytoplasm ratio. The aim of this study was to evaluate the use of hematoxylin in the differentiation of gastric lesions. Methods. Part 1. In a prospective study, a total of 70 different gastric abnormalities were stained with 1% hematoxylin solution during upper endoscopy. Results of histological examinations were compared with endoscopic findings. Part 2. During a 5-day period, antral mucosa was stained with hematoxylin in all patients (n = 26), independent of the upper endoscopy results. Grades of stained mucosa were compared with the proliferating cell nuclear antigen (PCNA) index, which was examined using an immunohistochemical method. Part 3. Gastric biopsies (total, 12) were obtained from the stained and unstained areas within the limits of one lesion (total, 6) after chromoscopy with hematoxylin and examined with monoclonal (PCNA) antibodies. Results. Using histological findings, the sensitivity and specificity of chromoendoscopy with hematoxylin for detecting gastric neoplasia and adenocarcinoma were determined. A significant positive correlation (r = 0.81; P < 0.001) was found between the PCNA index and grade of endoscopic stained mucosa. The PCNA index was increased in stained areas of gastric abnormalities in comparison to unstained areas within the limits of one lesion in all six patients. Conclusion. Chromoendoscopy with hematoxylin increases opportunities for precision biopsy. The grade of endoscopic stained mucosa depends on epithelial cell proliferation and is associated with malignancy. By using histology as the main outcome, the sensitivity and specificity of chromoendoscopy with hematoxylin for diffuse staining in the detection of gastric neoplasia and adenocarcinoma were 92.9% and 89.3%, respectively.