Diagnostic endoscopy of the upper digestive tract employs complementary methods such as aimed brush cytology and biopsy which, when used together, provide a diagnostic accuracy of almost 100 % in cases of early cancer. In the esophagus, chronic esophagitis is correlated with an increasing frequency of esophageal cancer, particularly in high incidence areas for this type of cancer. A cooperative project with the IARC-WHO was carried out to study esophageal cancer in a high risk area of China. Of 185 patients who underwent aimed cytology, 20 (1.8 %) were found to be carriers of various degrees of dysplasia which could not be endoscopically or hisiologically diagnosed. The importance of brush cytology should be stressed to confirm or rule out the presence of a malignant tumor in cases of esophageal stenosis which prevents having a direct view of the lesion. Brush cytology has also proven to be particularly useful in the diagnostic assessment of precancerous lesions of the stomach, such as chronic atrophic gastritis and gastric ulcer. In fact, by using criteria based on the grading of cell maturation, 112 cases of atrophic gastritis, out of a group of 400 patients with endoscopic findings of ≪ patchy ≫ gastritis, could be identified. A good agreement (95.5 %) was found between the cytologic and histologic diagnoses. In another study involving 117 subjects with gastric ulcer, 8 cases of ulcer-cancer were revealed. In 5 of these cases (71.5 %), brush cytology was crucial in the diagnosis and permitted diagnosing 1 case of ≪ in situé situ ≫ gastric cancer which developed on a histologically negative ulcer. Gastric brush cytology is also useful when dealing with subjects with a history of gastric surgery. These patients are often carriers of widespread lesions of the stump and the healing processes can often raise doubts at histology or even give false negative results. In these cases, brush cytology takes cell samples from the entire suspect area and may therefore permit the early diagnosis of dysplasia and malignancy.
- aimed cytology
- precancerous lesions
- upper digestive tract
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging