背景:动脉炎和肾小管炎,急性肾移植排斥反应的诊断特征,通常是局灶性病变。为了避免诊断不足,Banff\'97模式建议准备多张幻灯片,其中三个应该用苏木精和伊红(H&E)染色,三个应该用高碘酸希夫(PAS)或银染色。在这项研究中,我们检查Banff\'97建议的有效性,并确定这些建议的应用范围。
方法:我们回顾了52个显示急性肾小管间质和血管排斥的连续肾移植活检标本。每个H&E幻灯片对动脉炎进行分级,对每种H&E和PAS/silver进行分级。通过问卷调查确定了英国同种异体肾活检标本的处理。
结果:当两个,而不是三个,检查了H&E幻灯片,11.4%的病例漏诊了动脉炎;当只检查一个H&E载玻片时,33.3%的病例漏诊动脉炎。当只有一个,而不是三个,检查PAS/银色载玻片,33.3%的病例中,胃管炎的分级偏低.在英国,40%的实验室用H&E染色至少3张载玻片,和42%用PAS/银染色至少三个载玻片。只有30%的实验室符合所有Banff指南的载玻片制备。
结论:如果不实施Banff\'97载玻片制备指南,可能存在严重的急性排斥反应诊断不足和分级不足。英国的大多数实验室都不符合这些指南。
BACKGROUND: Arteritis and tubulitis, the diagnostic features of acute renal allograft rejection, are typically focal lesions. To avoid under-diagnosis, the Banff \'97 schema recommends the preparation of multiple slides, of which three should be stained with hematoxylin and eosin (H&E) and three with periodic acid-Schiff (PAS) or silver. In this study, we examine the validity of the Banff \'97 recommendations and determine how widely these recommendations are applied.
METHODS: We reviewed 52 consecutive renal transplant biopsy specimens showing both acute tubulointerstitial and vascular rejection.
Arteritis was graded for each H&E slide, and tubulitis was graded for each H&E and PAS/silver. The handling of renal allograft biopsy specimens in the U.K. was determined by means of a questionnaire.
RESULTS: When two, as opposed to three, H&E slides were examined, arteritis was missed in 11.4% of cases; when only one H&E slide was examined, arteritis was missed in 33.3% of cases. When only one, as opposed to three, PAS/silver slide was examined, tubulitis was under-graded in 33.3% of cases. In the U.K., 40% of laboratories stain at least three slides with H&E, and 42% stain at least three slides with PAS/silver. Only 30% of laboratories conform to all the Banff
guidelines for slide preparation.
CONCLUSIONS: There is likely to be significant under-diagnosis and under-grading of acute rejection if the Banff \'97
guidelines for slide preparation are not implemented. Most laboratories in the U.K. do not conform to these
guidelines.