Listen to Article
Gomori methenamine silver (GMS) stains are commonly used for esophageal biopsies in order to determine if a sample has fungal esophagitis. During this process, many labs require two GMS-stained levels, but is it necessary and cost effective?
In an article published in the Journal of Histotechnology, researchers Michael Occidental from The Ronald O. Perelman Department of Dermatology at NYU Langone Grossman School of Medicine; Andrew Dunn of Hattiesburg Clinic’s Department of Pathology and Dermatopathology; and Aaron R. Huber from the University of Rochester Medical Center tackled that question.
In order to find the answer, the group looked at 127 esophageal biopsy specimens in the lab’s archives, which were performed from 2017 to 2018. Two gastrointestinal pathologists reviewed the anonymized samples, which established a consensus. The time the pathologists spent working on each case—from the moment they put the slide on the microscope until fungal elements were detected—was recorded, along with the presence of fungal organisms, the number of levels performed, and which levels included the fungal elements.
The researchers found that an experienced histotechnologist cutting six separate biopsies could complete their work in 82.5 seconds per block to create three levels. This amounts to about 30 seconds per level, which includes the time to pare into the block, section the tissue, and take the sections out of the water bath and place them onto slides. In addition, the histologists were able to do up to ten MS stains manually by hand simultaneously in 35 minutes. However, this time did not include other pre-staining or post-staining procedures. At this rate, 2,400 manual stains would take 1,400 hours per year.
The results of the study, which appeared in the authors’ “Multiple levels of Gomori methenamine silver (GMS) stains do not improve diagnostic yield in esophageal biopsies” article, were clear: Special stains may not be as cost effective as labs may think they are.
Researchers found that of the 127 biopsies that were reviewed, 62, or 49%, tested positive for fungal elements on the GMS stains, while 65 (51%) did not have fungal elements. Of the positive cases, 98% had fungal elements on all levels, and only once were fungal elements detected on the first level but not on the second. Since the additional levels did not yield better results, study authors concluded that this method is not the most efficient use of histologists’ time.
“If it requires an estimated extra 30 seconds per level for the histotechnologist and 60 of the cases did not need extra levels; at least 30 minutes of unnecessary time was spent sectioning levels that were not helpful diagnostically,” the authors wrote. “Additionally, 84 of the cases had at least two levels on the slide that were unnecessary, which amounts to an additional 42 minutes of time. Therefore, nearly one hour and a half of extra time was done to prepare levels for these GMS assays that were not diagnostically helpful.”
As laboratories continue to navigate staffing shortages and rising workloads, studies like this one offer valuable guidance on how to streamline processes without compromising diagnostic accuracy. The evidence presented by Occidental, Dunn, and Huber makes a compelling case that routinely cutting multiple GMS-stained levels provides little added benefit while consuming meaningful time and resources. By reconsidering long‑standing practices and adopting data‑driven adjustments, labs can better support their teams and improve overall efficiency. For readers interested in exploring the full findings and their broader implications, the complete study is published in Issue 4 of the Journal of Histotechnology—a timely reminder of how thoughtful quality‑improvement efforts can reshape everyday laboratory practice. Members can access the the most recent issue by going to their dashboard and clicking on Journal of Histotechnology.
Need CEUs? Check out this free to members JOH Quiz based on this article here.
#2026
#Blog
#GeneralAnatomicPathology
#JOH