Diagnostic Utility of Endoscopic Crush Cytology in Gastrointestinal Malignancies

Gastrointestinal (GI) cancers represent one of the most pressing global public health challenges, accounting to nearly one-third of all cancer-related mortality worldwide. Cytological evaluation allows rapid interpretation and triaging of material. Crush cytology is an added asset to histology to maximize diagnostic accuracy and accelerate decision-making for the management of these lesions. This study aimed to assess the diagnostic utility of endoscopic crush cytology in GI tract lesions.

A cross-sectional observational study was conducted on GI crush cytology samples received at department of pathology from January 2019 to December 2024. These cases were cytologically categorized across various GI sites as follows, negative for malignancy, atypical favors reactive, atypical suspicious for malignancy and positive for malignancy. The corresponding biopsy slides were reviewed and documented. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated.

During the study period, we reviewed 303 cases of GI crush cytology. The mean age at presentation was 60 years (age range: 17-90 years) with a male-to-female ratio of 2:1. These cases were categorized into lower GI with 151 (49.8%) cases and upper GI with 152 (50.2%) cases. The most common site of involvement was colorectal with 146 (48.2%) cases followed by gastric region with 58 (19.1%) cases and esophagus with 31 (10.2%) cases. Negative for malignancy accounts for 7 (2.3%) cases, atypical favors reactive accounts for 120 (39.6%) cases, atypical suspicious for malignancy accounts for 4 (1.3%) cases, and positive for malignancy accounts for 172 (56.8%) cases across the GI region. Histopathology correlation was available in 179 (59.1%) cases. The overall GI crush cytology sensitivity was 96.1%, specificity was 96.2%, PPV was 98.4%, NPV was 90.9% and the diagnostic accuracy was 96.1%. The Youden's index was 0.9222, and the p value was <0.001 (χ2).

Crush cytology is a highly sensitive, specific, rapid, and cost-effective technique for diagnosing GI malignancies in endoscopically suspected malignant lesions. It is a valuable complement to histology, enhancing diagnostic accuracy and accelerating decision-making to manage these lesions. The present study highlights the significant diagnostic utility of crush cytology by demonstrating high sensitivity, specificity, and diagnostic accuracy, particularly in detecting adenocarcinomas and squamous cell carcinomas.