Brush cytology vs. endoscopic biopsy for the surveillance of Barrett's esophagus

Periodic surveillance with systematic biopsies is recommended for patients with Barrett's esophagus. Brush cytology has been proposed as a simple inexpensive component of endoscopic surveillance, which may also detect abnormalities prior to detection of histologic abnormalities. The aim of the current study was to determine whether brush cytology provides any additional value over endoscopic surveillance biopsies in patients with Barrett's esophagus.

This retrospective cohort study included 530 patients with Barrett's esophagus undergoing endoscopic surveillance with paired biopsy and cytology specimens at the Cleveland Clinic between January 1994 and July 2008. The main outcome measures were sensitivity, specificity, and concordance rates of cytology and histology.

Sensitivity of cytology for any dysplasia was 49 % and specificity was 95 %. However, sensitivity was 82 % for detection of high grade dysplasia/adenocarcinoma but only 31 % for low grade/indefinite for dysplasia. The concordance rate between cytology and histology was 80 %. Histology had a higher dysplasia detection rate than cytology (24.0 % vs. 15.7 %, respectively; P <0.0001).

Cytology has excellent specificity and good sensitivity for the detection of high grade dysplasia/adenocarcinoma but poor sensitivity for low grade dysplasia. There was substantial concordance between cytology and histology for the detection of dysplasia. However, histology had a higher dysplasia detection rate and therefore the value of routine cytology in the surveillance of Barrett's esophagus is questionable.