Adjunctive endoscopic brush cytology in the detection of upper gastrointestinal malignancy

The role of exfoliative cytology as an adjunct to endoscopic biopsy in the detection of upper gastrointestinal malignancy is controversial insofar as some claim that its use is of little clinical benefit. The role of cytology in the differentiation of benign from malignant mucosal lesions in 2,183 consecutive patients who underwent esophagogastroduodenoscopy was examined. Malignancy was confirmed in 394 patients. Both endoscopic biopsy and cytology were positive in 275 of 394 (69.8%) patients. Endoscopic biopsy provided the diagnosis in the presence of negative cytology in 73 of 394 (18.5%) cases, while cytology was positive after a negative biopsy in 36 of 394 (9.2%) patients. Ten of 394 (2.5%) patients were not diagnosed preoperatively using either modality. Endoscopic biopsy yielded a sensitivity of 88.3%, specificity of 99.9%, positive predictive value of 99.7% and negative predictive value of 97.6%. Cytology alone, in contrast, yielded a sensitivity of 79%, specificity of 98.5%, positive predictive value of 92.3% and negative predictive value of 95.6%. With the additional use of cytology, the diagnostic yield was increased from 88.3% to 97.5%. We conclude that upper gastrointestinal exfoliative cytology is a useful adjunct in the investigation of patients with suspicious mucosal lesions.