Current issue
Archive
Online first
About the Journal
Editorial Office
Editorial Board
Publisher
Editorial Policies
Ethical standards and procedures
Abstracting and indexing
Reviewers
Honorary Reviewers
Subscription
Contact
Most read articles
Instructions for authors
Article processing charge (APC)
Books and Events
Books
Events
ORIGINAL PAPER
Higher detectability of amyloid with phenol Congo red compared with alkaline Congo red
1
Department of Pathology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
2
Department of Cardiomyopathy, Cardinal Wyszynski National Institute of Cardiology, Warsaw, Poland
3
Department of Gerontology, Public Health and Education, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
Submission date: 2024-06-21
Final revision date: 2024-07-30
Acceptance date: 2024-08-16
Online publication date: 2024-11-06
Corresponding author
Marta Legatowicz-Koprowska
Department of Pathology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 1 Spartanska St., 02-637 Warsaw, Poland
Department of Pathology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 1 Spartanska St., 02-637 Warsaw, Poland
KEYWORDS
TOPICS
Rheumatoid arthritis- aetiology, pathogenesis, clinical features and treatmentSpondyloarthropaties - aetiology, pathogenesis clinical features and treatmentDiagnostics and imaging in rheumatic diseases
ABSTRACT
Introduction:
Amyloidosis is a heterogeneous group of conditions associated with tissue deposition of insoluble abnormal proteins that damage vital organs. Early diagnosis, when the deposits are minimal, determines the prognosis and requires histological confirmation. The commonly adopted gold standard technique is alkaline Congo red (ACR) staining, though its sensitivity is limited. There is a need for a simple and inexpensive screening method offering a better chance of detecting minimal amyloid deposits. The aim of this study was to compare amyloid detectability with ACR and phenol Congo red (PHCR) staining techniques for early detection of minimal deposits.
Material and methods:
We assessed 452 tissue specimens (including adipose tissue, gastrointestinal mucosa, labial salivary gland, myocardium, and bone marrow) from 425 patients with clinically suspected systemic or local amyloidosis, which had been sent to the Pathology Laboratory of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw. Adjacent sections from each specimen were stained with ACR and PHCR. If amyloid was detected, immunohistochemical typing was conducted. The consistency of the two staining methods was expressed as Cohen’s κ coefficient.
Results:
A total of 169 tissue specimens (37%) yielded positive readings, with 93 cases ACR(+) and PHCR(+); 75 cases ACR(–) and PHCR(+), and 1 case ACR(+) and PHCR(–). The percentage agreement between the staining methods was 83%, with the Cohen’s κ coefficient value of 0.60 (95% CI: 0.52–0.69), which corresponds to moderate agreement according to Fleiss. Additional immunohistochemical amyloid typing, conducted in ACR(–) and PHCR(+) specimens, yielded conclusive results in 82% of cases.
Conclusions:
The use of PHCR staining as a screening method in suspected amyloidosis improves amyloid (light chain, transthyretin, and amyloid A protein) detectability in various tissues. The PHCR staining specificity should be verified via electron microscopy and/or mass spectrometry.
Amyloidosis is a heterogeneous group of conditions associated with tissue deposition of insoluble abnormal proteins that damage vital organs. Early diagnosis, when the deposits are minimal, determines the prognosis and requires histological confirmation. The commonly adopted gold standard technique is alkaline Congo red (ACR) staining, though its sensitivity is limited. There is a need for a simple and inexpensive screening method offering a better chance of detecting minimal amyloid deposits. The aim of this study was to compare amyloid detectability with ACR and phenol Congo red (PHCR) staining techniques for early detection of minimal deposits.
Material and methods:
We assessed 452 tissue specimens (including adipose tissue, gastrointestinal mucosa, labial salivary gland, myocardium, and bone marrow) from 425 patients with clinically suspected systemic or local amyloidosis, which had been sent to the Pathology Laboratory of the National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw. Adjacent sections from each specimen were stained with ACR and PHCR. If amyloid was detected, immunohistochemical typing was conducted. The consistency of the two staining methods was expressed as Cohen’s κ coefficient.
Results:
A total of 169 tissue specimens (37%) yielded positive readings, with 93 cases ACR(+) and PHCR(+); 75 cases ACR(–) and PHCR(+), and 1 case ACR(+) and PHCR(–). The percentage agreement between the staining methods was 83%, with the Cohen’s κ coefficient value of 0.60 (95% CI: 0.52–0.69), which corresponds to moderate agreement according to Fleiss. Additional immunohistochemical amyloid typing, conducted in ACR(–) and PHCR(+) specimens, yielded conclusive results in 82% of cases.
Conclusions:
The use of PHCR staining as a screening method in suspected amyloidosis improves amyloid (light chain, transthyretin, and amyloid A protein) detectability in various tissues. The PHCR staining specificity should be verified via electron microscopy and/or mass spectrometry.
REFERENCES (14)
1.
Buxbaum JN, Dispenzieri A, Eisenberg DS, et al. Amyloid nomenclature 2022: update, novel proteins, and recommendations by the International Society of Amyloidosis (ISA) Nomenclature Committee. Amyloid 2022; 29: 213–219, DOI: 10.1080/13506129.2022.2147636.
2.
Quarta CC, Fontana M, Damy T, et al. Changing paradigm in the treatment of amyloidosis: from disease-modifying drugs to anti-fibril therapy. Front Cardiovasc Med 2022; 9: 1073503, DOI: 10.3389/fcvm.2022.1073503.
3.
Picken MM. Modern Approaches to the treatment of amyloidosis: the critical importance of early detection in surgical pathology. Adv Anat Pathol 2013; 20: 424–439, DOI: 10.1097/PAP.0b013e3182a92dc3.
4.
Garcia-Pavia P, Rapezzi C, Adler Y, et al. Diagnosis and treatment of cardiac amyloidosis: a position statement of the ESC Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2021; 42: 1554–1568, DOI: 10.1093/eurheartj/ehab072.
5.
Puchtler H, Sweat F, Levine M. On the binding of Congo red by amyloid. J Histochem Cytochem 1962; 10: 355–364, DOI: doi.org/10.1177/10.3.355.
6.
Gilbertson JA. Amyloid. In: Suvarna KS, Layton C, Bancroft JD (eds.). Bancroft’s theory and practice of histological techniques. 8th ed. Elsevier; 2018; 231–253.
7.
Linke RP. Congo red staining of amyloid: improvements and practical guide for a more precise diagnosis of amyloid and the different amyloidoses. In: Uversky VN, Fink AL (eds.). Protein Misfolding, Aggregation, and Conformational Diseases. Vol. 4. Springer US; 2006; 239–276, DOI: 10.1007/0-387-25919-8_12.
8.
Naiki H, Sekijima Y, Ueda M, et al. Human amyloidosis, still intractable but becoming curable: the essential role of pathological diagnosis in the selection of type-specific therapeutics. Pathol Int 2020; 70: 191–198, DOI: 10.1111/pin.12902.
9.
Linke RP. Diagnosis of Minimal amyloid deposits using the Congo red fluorescence method: a review. In: Picken M, Dogan A, Herrera G (eds.). Amyloid and Related Disorders. Current Clinical Pathology. Humana Press; 2012; 175–185, DOI: 10.1007/978-1-60761-389-3_13.
10.
Picken MM, Westermark P. Amyloid detection and typing: summary of current practice and recommendations of the consensus group. Amyloid 2011; 18 (Suppl 1): 48–50, DOI: 10.3109/13506129.2011.574354017.
11.
Bonderman D, Agis H, Kain R, et al. Amyloid in the heart: an underrecognized threat at the interface of cardiology, haematology, and pathology. Eur Heart J Cardiovascular Imaging 2016; 17: 978–980, DOI: 10.1093/ehjci/jew130.
12.
Ishii W, Matsuda M, Nakamura N, et al. Phenol Congo red staining enhances the diagnostic value of abdominal fat aspiration biopsy in reactive AA amyloidosis secondary to rheumatoid arthritis. Intern Med 2003; 42: 400–405, DOI: 10.2169/internalmedicine.42.400.
13.
Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics 1977; 33: 159–174.
14.
Rezk T, Gilbertson JA, Mangione PP, et al. The complementary role of histology and proteomics for diagnosis and typing of systemic amyloidosis. J Pathol Clin Res 2019; 5: 145–153, DOI: 10.1002/cjp2.126.
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Share
RELATED ARTICLE
| eISSN: | 2084-9834 |
| ISSN: | 0034-6233 |
We process personal data collected when visiting the website. The function of obtaining information about users and their behavior is carried out by voluntarily entered information in forms and saving cookies in end devices. Data, including cookies, are used to provide services, improve the user experience and to analyze the traffic in accordance with the Privacy policy. Data are also collected and processed by Google Analytics tool (more).
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
You can change cookies settings in your browser. Restricted use of cookies in the browser configuration may affect some functionalities of the website.
