# 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

## TL;DR

This study compares three staining methods for detecting Helicobacter pylori in gastric biopsies and finds that Giemsa is the most reliable, while H&E is the most cost-effective.

## Contribution

The study provides a comparative analysis of the diagnostic accuracy and cost-effectiveness of H&E, AB/PAS, and Giemsa stains for H. pylori detection.

## Key findings

- Giemsa stain showed superior diagnostic performance compared to H&E and AB/PAS.
- H&E was the most cost-effective and fastest method but lacked sufficient sensitivity for definitive diagnosis.
- AB/PAS was found to be the most expensive and time-consuming method with lower diagnostic accuracy.

## Abstract

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.

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.

H&E showed a sensitivity of 51.6%, specificity of 74.4%, and diagnostic accuracy of 66.4%, while AB/PAS had a sensitivity of 45.9%, specificity of 73.2%, and accuracy of 63.7%. H&E was the most cost-effective and fastest method; AB/PAS was the most expensive and time-consuming. Giemsa demonstrated superior diagnostic performance.

H&E offers practical benefits for screening but lacks sufficient sensitivity for definitive diagnosis. AB/PAS is less effective and less economical. Giemsa remains the most reliable stain for
H. pylori detection. Combining H&E with Giemsa may optimize both efficiency and diagnostic accuracy. Further prospective studies are warranted.