A novel Alcian yellow-toluidine blue (Leung) stain for Helicobacter species: comparison with standard stains, a cost-effectiveness analysis, and supplemental utilities.

Helicobacter pylori (Hp) gastritis is a worldwide problem significantly associated with duodenal and gastric peptic ulcer disease, gastric carcinomas, and MALT-type lymphomas. A simple, rapid, reproducible, reliable, and inexpensive stain to detect the organism in gastric biopsy specimens is thus of great value. To assess the reliability and cost-effectiveness of a novel Alcian yellow-toluidine blue (Leung) stain for Hp, we stained 60 endoscopic mucosal biopsy specimens from patients with Hp gastritis and measured time to detection of organism, Hp numbers (scale, 1-5), and technical costs. We also stained serial 5-microm step sections of 17 of these cases with the Giemsa and modified Steiner (MS) methods, and similar measurements were made. Also, specimens from various normal gastrointestinal sites and metaplastic lesions, as well as four cases each of giardiasis and cryptosporidiosis, were stained with the Leung method. In the subset of 17 cases, the Leung stain enhanced detection time and compared favorably with the Giemsa method, though the MS method was somewhat superior. Hp scores were similar among all groups. Mean time to detection and Hp scores were similar in the larger (n = 60) group stained with hematoxylin and eosin and the Leung stain. Material costs and technologist's time for Giemsa stains, however, were greater than for the Leung stain, and technologist's time for MS was nearly fourfold that of the Leung stain. With the Leung method, mucus from all gastrointestinal sites and metaplastic lesions stained yellow, and this stain provided excellent contrast and morphologic definition in giardiasis and cryptosporidiosis. We suggest that the newly developed Alcian yellow-toluidine blue (Leung) histochemical stain is a good choice as the standard for routine Hp staining because it is the cheapest and easiest to prepare and because pathologists' detection with this stain compares favorably with detection times achieved with more traditional and established methods.