Hematoxylin and eosin stain shows a high sensitivity but sub-optimal specificity in demonstrating iron pigment in liver biopsies

BACKGROUND: Perls’ stain is routinely used to demonstrate iron in liver biopsies. We tested the hypothesis that it may be unnecessary in cases, where no iron or another similar pigment was seen on the routine hematoxylin and eosin (H and E) stained section. AIM: The aim of this study was to evaluate the efficiency of H and E stain in demonstrating iron in liver biopsies as well as to determine the possibility of replacing Perls’ stain with H and E stain. MATERIALS AND METHODS: Two hundred pairs of slides of liver biopsies were taken from the archival files of the Department of Pathology from 2006 to 2011. Perls’ and H and E slides were independently reviewed for the presence of iron. RESULTS: Hundred and one cases showed the presence of iron using H and E stain. 84 of 86 cases showed positive iron using both Perls’ and H and E stains. Seventeen cases were positive using H and E stain but negative with Perls’. Only two cases did not show the presence of iron using H and E stain. Ninety-seven cases were negative using both Perls’ and H and E stains. H and E stain showed a sensitivity, specificity, accuracy, positive predictive valve, and negative predictive value of 97.67%, 85.08%, 90.5%, 83.16%, and 97.98%, respectively. CONCLUSION: We demonstrate that the H and E stain is a sensitive method to detect iron pigment in liver biopsies, particularly when present in large quantities. A negative H and E stain might obviate the need for extra Perls’ staining, thus saving costs and shortening report turn-around times.