Multiple levels of Gomori methenamine silver (GMS) stains do not improve diagnostic yield in esophageal biopsies

Gomori methenamine silver (GMS) stains are commonly utilized to exclude fungal esophagitis in esophageal biopsies. Our laboratory protocol for special stains, including GMS, stipulates that two levels be performed for each stain. We retrospectively reviewed 127 esophageal biopsies which had GMS stains performed; there were 62 GMS-positive and 65 GMS-negative cases. Sixty-one of the positive cases (98%) had fungal organisms present on all levels. Only one case showed fungal elements on the first, but not the second, level. Given national laboratory staff shortages, performing levels for special stains may be unnecessary, inefficient, and time consuming in the surgical pathology laboratory.