Reliability of haematoxylin and eosin staining in the diagnosis of hodgkin's disease in uganda.

Abstract

BACKGROUND: Whereas immunohistochemical methods have been widely used for the diagnosis and classification of Hodgkin’s disease in the developed countries, there are very few reports of their use in the developing countries where haematoxylin and eosin is the mainstay of diagnosis of Hodgkin’s disease. Yet the diagnostic accuracy of haematoxylin and eosin has not been assessed in Uganda. OBJECTIVES: The objective of the study was to determine the reliability of haematoxylin and eosin staining in the diagnosis of Hodgkin’s disease using immunohistochemistry as the reference standard. It also sought to classify the difference immunophenotypic and histologic types of Hodgkin’s disease seen in Uganda. METHODOLOGY: In this laboratory-based study of a diagonostic method, 240 paraffin embedded biopsies seen in the Makerere University Department of pathology from 1980-2000 were studied. The formallin fixed, paraffin embedded tissue sections were assessed and subjected to immunohistochemical methods using monoclonal antibodies including leucocyte common antigen, LCA (CD 45), Anti bodies to Reed-Sternberg cells (CD 15, CD 30) and antibodies to B cells (CD 20). The sensitivity, specificity, positive predictive value and negative predictive value were assessed. The overall kappa score was to assess the agreement between the two diagnostic tests. RESULTS: Of the 240 biopsies, 17 (71.3%) were confirmed as Hodgkin’s disease by immunohistochemistry. Using haematoxylin and eosin (H & E), only 131 of the 171 cases of Hodgkin’s disease were detected. The mean age of the 171 cases was 26.1 (SD 16.2) years, with a mode of 20.0 and the median of 22.5 years.. The 15-24 year age group was the most affected (47.2%). There were more males (65.9%) than females and most were baganda the dominant tribe in the central region where Makerere University and Mulago Hospital are located. The sensitivity, specificity, positive and negative predictive values of haemtoxylin and eosin were 76.61%, 92.75%, 96.32% and 61.53% respectively. The agreement between the two tests was 81.25% with an overall measure of agreement, Kappa of 0.602. Mixed cellularity (35.7%) and lymphocyte depleted (24.6%) Hodgkin’s diseases were the commonest histological types. Classic hodgkin’s disease (CD 30+, CD 15+, CD 20-, CD45-) was the commonest (77.8%) immunophenotype. CONCLUSION: Haematoxylin and eosin has relatively high efficacy in the diagnosis of Hodgkin’s disease. Classic Hodgkin’s disease is the commonest immunophenotype while mixed cellularity and lymphocyte depleted were the main histologic subtypes. Use of haematoxylin and eosin is still recommended for the diagnosis of Hodgkin’s disease, reserving the expensive (USD 20 per test) immunohistochemistry for difficult cases.