Reliability of the Acetylcholinesterase (ACE) Reaction in Rectal Mucosal Biopsies for the Diagnosis of Hirschsprung's Disease

Staak, F. H. J. van der

doi:10.1055/s-2008-1063295

Cited by 12 publications

(7 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Although the use of AChE is of value, there are several potential problems, including false negative/positive results, the need for a frozen tissue, and the difficulty of reproducing the reaction in a reliable fashion. False positive staining [ 9 , 15 – 17 ] is seen occasionally in hemorrhagic specimens (due to the high concentrations of AChE in the red blood cell membrane), in colitis and in intestinal neuronal dysplasia. False negative results [ 16 , 18 – 20 ] occur in neonates, in TCA and in ultra short segment HD, technical factors, poor orientation of the minute biopsy, focal increase in AChE activity that may be missed and inexperienced hands.…”

Section: Discussionmentioning

confidence: 99%

Acetylcholinesterase histochemistry (AChE) - A helpful technique in the diagnosis and in aiding the operative procedures of Hirschsprung disease

et al. 2015

View full text Add to dashboard Cite

BackgroundHirschsprung’s disease (HD) is an anomaly characterized by the absence of myenteric and submucosal ganglion cells (GC) in the distal alimentary tract. Diagnosis of HD is made by the absence of GC and missing out on even a single ganglion cell can be very devastating. Acetylcholinesterase (AChE) histochemistry, done on frozen sections is said to be a very useful ancillary technique in the diagnosis and in aiding the operative procedures of HD.MethodsTo assess this, 73 samples from 42 suspected/known cases of HD were subjected to frozen section analysis with rapid haematoxylin and eosin, toluidin blue stain along with AChE histochemistry. The remnant sample was paraffin embedded for routine haematoxylin and eosin staining.ResultsOn frozen section analysis, 33 samples showed absence of ganglion cells, AChE histochemistry showed a positive staining pattern in 17 samples and paraffin embedded routine, H&E stained sections showed absence of ganglion cells in 19 samples. Sensitivity and specificity of both tests ie frozen section rapid H&E/AChE histochemistry in the diagnosis of HD, were calculated taking paraffin embedded H&E stained sections as the gold standard. Sensitivity of frozen section rapid H&E in the diagnosis of HD is 57.57 % and specificity is 79.10 %. The p-value is <0.0001, which is significant. The sensitivity of AChE histochemistry in the diagnosis of HD is 90.47 % and specificity is 96.36 %. The p-value is <0.0001, which is significant.ConclusionsAcetylcholineesterase (AChE) histochemistry is a very useful ancillary technique in the diagnosis and in aiding the operative procedures of HD. It acts as a double check in the diagnosis of HD.

show abstract

Section: Discussionmentioning

confidence: 99%

Acetylcholinesterase histochemistry (AChE) - A helpful technique in the diagnosis and in aiding the operative procedures of Hirschsprung disease

et al. 2015

View full text Add to dashboard Cite

show abstract

“…In our comparative study, reliance on rapid AChE alone resulted in a single false-positive diagnosis by 1 reviewer and another case with false-negative diagnoses by 2 reviewers. Others have evaluated the sensitivity and specificity of AChE in their own laboratories [16,[25][26][27][28][29]. In general, false-positive findings suggestive of HSCR are extremely rare; most studies report 100% specificity.…”

Section: Discussionmentioning

confidence: 99%

Calretinin Immunohistochemistry versus Acetylcholinesterase Histochemistry in the Evaluation of Suction Rectal Biopsies for Hirschsprung Disease

et al. 2009

View full text Add to dashboard Cite

Diagnosis of Hirschsprung disease (HSCR) relies on histologic and/or histochemical staining of sections from suction rectal biopsies. Acetylcholinesterase histochemistry (AChE) facilitates diagnosis but is not universally employed, in part because it requires special tissue handling. Calretinin immunohistochemistry (IHC) may be a useful alternative, because loss of calretinin immunoreactive nerves reportedly correlates spatially with aganglionosis. We investigated the patterns of calretinin IHC in suction rectal biopsies from HSCR and non-HSCR patients and compared the diagnostic value of calretinin IHC with a widely used rapid AChE method. In suction rectal biopsies that contain ganglion cells, small nerves in the lamina propria, muscularis mucosae, and superficial submucosa contain granular aggregates of calretinin immunoreactivity. Immunolabeling of these nerves is completely absent in the aganglionic biopsies of HSCR patients. Multiple observers independently reviewed calretinin IHC and AChE sections of suction rectal biopsies from 14 HSCR patients and 17 non-HSCR controls. Five observers, blinded to the correct diagnosis, scored each patient's calretinin IHC and AChE slides as HSCR, not HSCR, or equivocal. The frequencies of major and minor discrepant diagnoses were compared. Calretinin IHC yielded no misdiagnoses or major discrepancies between observers. In contrast, 2 misdiagnoses and significantly more interobserver disagreement resulted from the AChE-stained sections. Calretinin IHC appears to be a reasonable, and potentially superior, alternative to AChE as an adjunctive diagnostic method for evaluating suction rectal biopsies for HSCR.

show abstract

“…AChE staining is only suitable for the left colon and rectum, as the activity of the extramural parasympathetic system decreases proximally from the anal canal so that its activity approaches zero at the splenic flexure. 12 This means that histochemical staining of biopsies taken from the colon proximal to the splenic flexure, for example from a defunctioning colostomy site, is not suitable for determining the length of aganglionic segment. Frozen section facilities for conventional staining should therefore be available during definitive surgery for Hirschsprung's disease.…”

Section: Discussionmentioning

confidence: 99%

Clinical evaluation of the histochemical diagnosis of Hirschsprung's disease.

Barr¹,

Booth²,

Filipe³

et al. 1985

Gut

View full text Add to dashboard Cite

Reliability of the Acetylcholinesterase (ACE) Reaction in Rectal Mucosal Biopsies for the Diagnosis of Hirschsprung's Disease

Cited by 12 publications

References 8 publications

Acetylcholinesterase histochemistry (AChE) - A helpful technique in the diagnosis and in aiding the operative procedures of Hirschsprung disease

Acetylcholinesterase histochemistry (AChE) - A helpful technique in the diagnosis and in aiding the operative procedures of Hirschsprung disease

Calretinin Immunohistochemistry versus Acetylcholinesterase Histochemistry in the Evaluation of Suction Rectal Biopsies for Hirschsprung Disease

Clinical evaluation of the histochemical diagnosis of Hirschsprung's disease.

Contact Info

Product

Resources

About