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Staining for acid-fast bacilli in surgical pathology: practice patterns and variations.
Roseann I Wu1, Eugene J Mark, Jennifer L Hunt
1Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 20114, USA. riwu@partners.org
Human Pathology
|May 1, 2012
Summary
Pathologists show significant variation in ordering, interpreting, and reporting acid-fast bacilli stains in tissue samples. Standardizing these practices for diagnosing mycobacterial disease is crucial for improved patient outcomes.
Area of Science:
- Histopathology
- Microbiology
- Medical Diagnostics
Background:
- Acid-fast bacilli (AFB) stains are vital for diagnosing tuberculosis (TB) from sputum, but quality control in tissue diagnosis is less defined.
- Necrotizing granulomas in tissues correlate with mycobacterial cultures, yet pathologists' practices for AFB in surgical specimens are poorly documented.
Purpose of the Study:
- To characterize current practice patterns among pathologists regarding the ordering, interpretation, and reporting of acid-fast bacilli stains in histologic sections.
- To identify variations and potential areas for standardization in AFB stain analysis for mycobacterial disease diagnosis.
Main Methods:
- A survey was distributed to 1299 pathologists (Pulmonary Pathology Society members and randomly selected College of American Pathologists fellows).
- The survey included 21 questions covering demographics, stain ordering, interpretation methods (e.g., objective magnification), reporting, and correlation with clinical/culture data.
- A 30.2% response rate (392/1299) was achieved, with 363 respondents regularly reviewing AFB stains on histologic sections.
Main Results:
- Most respondents (363/392) review AFB stains on histologic sections, with practice settings split between academic and community settings.
- Significant variability exists in when AFB stains are ordered, the examination methods used (e.g., ×40 vs. ×100 oil immersion), reporting procedures, and follow-up for negative results.
- Many pathologists reported receiving no formal training in a general approach to AFB interpretation, highlighting a gap in education.
Conclusions:
- Substantial variation exists in all facets of AFB stain practice, from ordering to histologic examination and reporting.
- Standardizing the interpretation and reporting of acid-fast bacilli stains in surgical pathology could enhance the accuracy and consistency of mycobacterial disease diagnosis.
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