Role of brush cytology in the diagnosis of neoplastic and non-neoplastic upper gastrointestinal lesions

• Published in: Cytopathology (Oxford) Vol. 27; no. 6; pp. 407 - 417
• Main Authors: Muniraj, F., Siddaraju, N., Sistla, S. C.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.12.2016
• Subjects: Adenocarcinoma - diagnosis; Adenocarcinoma - pathology; Adult; Aged; Biopsy; brush cytology; Candida; Carcinoma, Squamous Cell - diagnosis; Carcinoma, Squamous Cell - pathology; Cytodiagnosis; endoscopic biopsy; Female; Gastrointestinal Neoplasms - diagnosis; Gastrointestinal Neoplasms - pathology; Helicobacter pylori; Humans; Male; Middle Aged; neoplastic lesions; non-neoplastic; upper gastrointestinal; endoscopic biopsy; non-neoplastic; brush cytology; upper gastrointestinal; neoplastic lesions
• ISSN: 0956-5507; 1365-2303
• DOI: 10.1111/cyt.12333

Objective To evaluate the utility of brush cytology (BC) in diagnosing non‐neoplastic and neoplastic lesions of the upper gastrointestinal (GI) tract. Methods The study comprised 106 brushings from 104 patients with clinically suspected lesions in the upper GI tract. Diagnoses were rendered on correlating brush cytological findings with clinicoradiological findings and compared with endoscopic biopsies (EB). An attempt was made to grade oesophageal squamous cell carcinomas (SCC) and to subcategorise gastric adenocarcinomas (AC). The sensitivity, specificity and predictive values of BC were calculated with respect to clinico‐radiological outcome. Results Malignant and benign lesions on BC comprised 74.5% and 25.5%, respectively, and on histology, 64.2% and 28.3%, respectively. Twenty‐one of 32 (65.6%) gastric ACs were accurately sub‐typed (16 intestinal and five diffuse) and 25/36 (69.4%) oesophageal SCCs (7, 15 and three well, moderately and poorly differentiated, respectively) were accurately graded. On correlation with the final clinico‐radiological diagnosis, there was one false‐positive and no false‐negative cases, respectively, on BC; three false‐negative and no false‐positive cases, respectively, on EB; eight EB were non‐representative in which a diagnosis was not rendered, out of which seven were malignant. Thus, BC had a sensitivity and specificity of 100% and 96.4%, respectively, with a positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy (DA) of 98.7%, 100% and 99.1% (P ˂ 0.05), respectively. BC was superior to EB in detecting Candida species and EB in detecting Helicobacter pylori. Conclusions BC is a useful, routinely applicable and reliable test for diagnosing upper GI lesions. The authors report accuracy of 106 bronchial brush cytology samples with respect to clinico‐radiological outcome along with histology in a minority of cases: sensitivity of cytology was higher (100%) than endobronchial biopsies but there was one false positive.