Digitally reinforced hematoxylin-eosin polarization technique in diagnosis of rectal amyloidosis

Table 1 Distribution of amyloid types and clinical histories detected with digitally reinforced hematoxylin-eosin polarization and hematoxylin-eosin images among study group cases

Clinical history	Cases identified (n)
	Total	By DRHEP	By DRHEP only	By both DRHEP and HE	By HE	By HE only	By neither technique
AA-type amyloidosis
Ankylosing spondylitis	13	8	6	2	5	2	3
Familial mediterranean fever	13	8	3	5	5	0	5
Rheumatoid arthritis	10	5	4	1	2	1	4
Inflammatory bowel disease	6	5	3	2	2	0	1
Behcet’s disease	3	0	0	0	0	0	3
Tuberculosis	2	2	2	0	0	0	0
Chronic obstructive lung disease	2	2	1	1	1	0	0
Still syndrome	1	1	1	0	0	0	0
Reiter syndrome	1	1	1	0	0	0	0
Psoriasis	1	0	0	0	0	0	1
TRAPS	1	1	1	0	0	0	0
Chronic infection	1	1	1	0	0	0	0
Total	54	34	23	11	15	3	17
AL-type amyloidosis
Multiple myeloma	8	7	7	0	0	0	1
Plasma cell dyscrasia	1	1	0	1	1	0	0
Total	9	8	7	1	1	0	1
Amyloidosis-type undetermined
Hereditary amyloidosis1	10	7	3	5	4	1	2
Chronic renal failure	5	3	1	2	2	0	2
Plasma cell dyscrasia	1	1	0	1	1	0	0
Malignancy	4	4	2	2	2	0	0
Unknown causes	17	12	5	6	8	1	4
Total	37	27	11	16	17	2	8
Overall total	100	69	41	28	33	5	26

¹Transthyretin-related amyloidosis mutation was detected in one case. TRAPS: Tumor necrosis factor receptor-associated periodic syndrome; HE: Hematoxylin-eosin; DRHEP: Digitally reinforced hematoxylin-eosin polarization.

Table 2 Comparison of hematoxylin-eosin and digitally reinforced hematoxylin-eosin polarization evaluated by Congo-red stain n (%)

Variable	DRHEP	HE
Congo red positive (n = 100)
True positive	69 (69)	33 (33)
False negative	31 (31)	67 (67)
Congo red negative (n = 50)
True negative	49 (98)	16 (20)
False positive	1 (4)	34 (80)
Sensitivity	69%	34%
Specificity	98%	32%
Accuracy	78.6%	33.3%
Positive predictive value	98.5	50.0
Negative predictive value	61.3	19.5

HE: Hematoxylin-eosin; DRHEP: Digitally reinforced hematoxylin-eosin polarization.

Table 3 Distribution of hematoxylin-eosin and digitally reinforced hematoxylin-eosin polarization evaluation results for identifying the site of deposits confirmed by Congo-red polarization, n

Site of deposition	Confirmed by CRP	Identified by DRHEP						Identified by HE
		Total	P value	HE-/DRHEP+	P value	HE+/DRHEP+	P value	Total	P value	HE+/DRHEP-	P value	HE-/DRHEP-	P value
Vascular deposits only	74	48	0.24	31	0.982	17	0.147	21	0.381	4	0.823	22	0.407
Mixed deposits	26	21	0.24	10	0.982	11	0.147	12	0.381	1	0.823	4	0.407
Vascular, muscular	13	9	0.24	5	0.982	4	0.147	5	0.381	1	0.823	3	0.407
Vascular, muscular, interstitial	7	6	0.24	2	0.982	4	0.147	4	0.381	0	0.823	1	0.407
Vascular, interstitial	6	6	0.24	3	0.982	3	0.147	3	0.381	0	0.823	0	0.407
Total number of cases	100	69	-	41	-	28	-	33	-	5	-	26	-

HE: Hematoxylin-eosin; DRHEP: Digitally reinforced hematoxylin-eosin polarization; CRP: Congo-red polarization.

Table 4 Distribution of causes of false negativity by digitally reinforced hematoxylin-eosin polarization and clinical histories

Cause of false negativity	Total number of cases, n (%)	Clinical history	n	Amyloid type
Extensive refraction	12 (38.7)	Ankylosing spondylitis	2	AA
		Familial Mediterranean fever	1	AA
		Rheumatoid arthritis	1	AA
		Behcet’s disease	1	AA
		Psoriasis	1	AA
		Multiple myeloma	1	AL
		Chronic renal failure	1	Undetermined
		Hereditary	1	Undetermined
		Unknown causes	3	Undetermined
Tiny deposit ("Missed cases")	9 (29.0)	Ankylosing spondylitis	2	AA
		Familial Mediterranean fever	1	AA
		Rheumatoid arthritis	2	AA
		Inflammatory bowel disease	1	AA
		Behcet’s disease	1	AA
		Hereditary	1	Undetermined
		Unknown causes	1	Undetermined
Absence of the positive vessel	3 (9.7)	Familial Mediterranean fever	1	AA
		Behcet’s disease	1	AA
		Ankylosing spondylitis	1	AA
Perivascular illuminance	2 (6.5)	Familial Mediterranean fever	1	AA
		Rheumatoid arthritis	1	AA
Reason unidentified	5 (16.1)	Familial Mediterranean fever	1	AA
(Real negative? cases)		Rheumatoid arthritis	1	AA
		Chronic renal failure	1	Undetermined
		Unknown causes	1	Undetermined
		Hereditary	1	ATTR
Total number of cases	31 (100.0)		31

AA: Amyloid A; AL: Amyloid light-chain; ATTR: Transthyretin-related amyloidosis