title: Selective staining of gastric biopsies for H. pylori does not affect detection rates or turnaround time and improves cost compared to reflexive staining.
abstract: OBJECTIVE
  To evaluate how reflexive versus selective H. pylori stains affect detection rates, turnaround time (TAT), and cost savings in a real life practice environment following an institutional policy change.
  
  
  METHODS
  The aforementioned parameters were evaluated in all cases in the year preceding and the year following an institutional policy change from reflexive to selective staining.
  
  
  RESULTS
  1497 patients comprised the reflexive stain (RS) group of which 228 (15.2%) were H. pylori positive. 1629 patients comprised the selective stain (SS) group of which 237 (14.5%) were H. pylori positive. There was no significant difference in H. pylori detection rates between the RS and SS groups (OR=0.95, 95% CI=0.78-1.15, p=0.59). TATs were similarly equivalent with a mean of 52.4h for the RS cohort and 53.7h for the SS cohort (p=0.344), both of which included a resident preview day. We calculated an average laboratory cost savings of $11.68 per case, which saved our department over $15,000 (37%) in the year following the policy change.
  
  
  CONCLUSIONS
  Our results support a policy of selective staining for H. pylori as opposed to reflexive staining and go on to show that laboratories that change their policy can expect to generate cost savings without compromising detection rates or TAT.
authors.affiliation: University of New Mexico School of Medicine, Department of Pathology, Albuquerque, NM, United States.
authors.forename: Lauren
authors.initials: L
authors.lastname: Decker
authors.affiliation: University of New Mexico School of Medicine, Department of Pathology, Albuquerque, NM, United States.
authors.forename: Joshua Keith
authors.initials: JK
authors.lastname: Routh
authors.affiliation: Atlantic University School of Medicine, West Indies, Saint Lucia.
authors.forename: Jessica Sara
authors.initials: JS
authors.lastname: Snider
authors.affiliation: University of New Mexico School of Medicine, Department of Pathology, Albuquerque, NM, United States. Electronic address: jahanson@salud.unm.edu.
authors.forename: Joshua Anspach
authors.initials: JA
authors.lastname: Hanson
mesh_terms: D001706:Biopsy; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry / Q000191:economics*; D012680:Sensitivity and Specificity; D013194:Staining and Labeling / Q000191:economics*; D013270:Stomach / Q000382:microbiology* / Q000473:pathology; D013997:Time Factors
keywords: Chronic gastritis; Helicobacter pylori gastritis; Immunohistochemical detection; Infectious gastritis