title: Acetylcholinesterase histochemistry (AChE)--A helpful technique in the diagnosis and in aiding the operative procedures of Hirschsprung disease.
abstract: BACKGROUND
  Hirschsprung's disease (HD) is an anomaly characterized by the absence of myenteric and submucosal ganglion cells (GC) in the distal alimentary tract. Diagnosis of HD is made by the absence of GC and missing out on even a single ganglion cell can be very devastating. Acetylcholinesterase (AChE) histochemistry, done on frozen sections is said to be a very useful ancillary technique in the diagnosis and in aiding the operative procedures of HD.
  
  
  METHODS
  To assess this, 73 samples from 42 suspected/known cases of HD were subjected to frozen section analysis with rapid haematoxylin and eosin, toluidin blue stain along with AChE histochemistry. The remnant sample was paraffin embedded for routine haematoxylin and eosin staining.
  
  
  RESULTS
  On frozen section analysis, 33 samples showed absence of ganglion cells, AChE histochemistry showed a positive staining pattern in 17 samples and paraffin embedded routine, H&E stained sections showed absence of ganglion cells in 19 samples. Sensitivity and specificity of both tests ie frozen section rapid H&E/AChE histochemistry in the diagnosis of HD, were calculated taking paraffin embedded H&E stained sections as the gold standard. Sensitivity of frozen section rapid H&E in the diagnosis of HD is 57.57 % and specificity is 79.10 %. The p-value is <0.0001, which is significant. The sensitivity of AChE histochemistry in the diagnosis of HD is 90.47 % and specificity is 96.36 %. The p-value is <0.0001, which is significant.
  
  
  CONCLUSIONS
  Acetylcholineesterase (AChE) histochemistry is a very useful ancillary technique in the diagnosis and in aiding the operative procedures of HD. It acts as a double check in the diagnosis of HD.
authors.affiliation: Department of Pathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
authors.forename: R K
authors.initials: RK
authors.lastname: Agrawal
authors.affiliation: Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India. nandita_kakkar@yahoo.com.
authors.forename: Nandita
authors.initials: N
authors.lastname: Kakkar
authors.affiliation: Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
authors.forename: R K
authors.initials: RK
authors.lastname: Vasishta
authors.affiliation: Department of Histopathology, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
authors.forename: Vandana
authors.initials: V
authors.lastname: Kumari
authors.affiliation: Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
authors.forename: R
authors.initials: R
authors.lastname: Samujh
authors.affiliation: Department of Pediatric Surgery, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
authors.forename: K L N
authors.initials: KL
authors.lastname: Rao
mesh_terms: D000110:Acetylcholinesterase / Q000378:metabolism*; D001706:Biopsy / Q000379:methods; D002648:Child; D002675:Child, Preschool; D005260:Female; D005629:Frozen Sections / Q000379:methods; D006416:Hematoxylin; D006627:Hirschsprung Disease / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012680:Sensitivity and Specificity; D013194:Staining and Labeling / Q000379:methods
chemical_list: D000110:Acetylcholinesterase; D006416:Hematoxylin