CDX2 has a better positive predictive value than AB in detecting intestinal metaplasia. CDX2 may be useful when challenged by gastro-esophageal biopsies containing mimikers of BE.
BackgroundCDX2 is a nuclear homeobox transcription factor not expressed in normal esophageal and gastric epithelium but has been reported to highlight the intestinal metaplasia of the esophagus. In this study we investigate the utility of CDX2 in detecting Barrett's esophagus as compared to the conventional Alcian blue pH 2.5 special stain (AB).MaterialsPatients who underwent upper endoscopy to rule out Barrett's at the Florida Digestive Health Specialists and at the Moffitt Cancer Center within the past 12 months were selected. H&E biopsies slides and AB stains were reviewed. Cases were categorized as follows: 108 cases with histologically evident goblet cells (BE), 48 cases without histologic evidence of goblet cells (NBE), 43 cases containing esophageal glands (EG), and columnar blue cells (CB). These cases were stained for CDX2 following the manufacturer recommendations.ResultsWe reviewed a total of 199 esophago‐gastric biopsies from 186 patients. All 108 BE (100%) were positive for AB and 102 (94.4%) were positive for CDX2. 89.6% of 48 NBE were negative for AB and CDX2. 100% of 43 cases showing EG and CB were AB falsely positive. These cases were CDX2 negative. The positive predictive value in detecting intestinal metaplasia for CDX2 was 95.6% and for AB it was 71.5%.ConclusionAdjunct of CDX2 immunostain to AB helps in the evaluation of esophago‐gastric biopsies performed to rule out BE.
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