A new systematization of histological analysis for the diagnosis of Hirschsprung's disease

Author(s)

Serafini, Suellen ; Santos, Maria Merces ; Aoun Tannuri, Ana Cristina ; Di Loreto, Celso ; Goncalves, Josiane de Oliveira ; Tannuri, Uenis

• Document type: Journal article
• Source: Clinics; v. 78, p. 6-pg., 2023-04-18.

Abstract

Background: Hirschsprung's Disease (HD) is characterized by intestinal sub-occlusion and the absence of enteric ganglion cells. A rectal biopsy examination is performed to confirm the diagnosis. In a recent study, we demon-strated that the analysis of 60 sections of rectal mucosa and submucosa stained by H&E may ensure a 90% diag-nostic accuracy. Although the need to analyze so many sections makes the process of reading the slides more time-consuming, this encouraged us to study their distribution in the healthy rectal submucosa, to simplify the diagnosis.Objectives: To develop a method that facilitates HD diagnosis by studying the distribution of ganglion cells in the submucosal plexus. Methods: Using the calretinin technique, we studied the distribution of plexuses in 60 fragments of rectal submu-cosa from 19 cadavers. After the study, the reading method created was used for diagnosis in 47 cases of suspected HD, using H&E staining. The accuracy was verified by comparing the results obtained with H&E to those obtained with the acetylcholinesterase technique, the golden standard in our laboratory.Results: The study of submucosal plexus distribution showed that just by examining the submucosal region every 20 mu m, approximately, it is possible to locate a ganglionic plexus, and we have already been able to diagnose HD with 93% accuracy. Conclusion: The study of ganglion cell distribution enabled the creation of a simplified method for reading the slides. The method applied achieved good accuracy and it can be used as an alternative method in HD diagnosis. (AU)

• FAPESP's process: 19/10339-1 - Distribution of ganglion cells in rectal mucosal and submucosal fragments for the diagnosis of hirschsprung disease
• Grantee: Uenis Tannuri
• Support Opportunities: Regular Research Grants