Endoscopic biopsies and cytologic brushings of the esophagus are diagnostically complementary

It is traditionally taught that concurrently obtained endoscopic tissue biopsies and cytologic brushings from the esophagus are diagnostically complementary. This contention is supported mostly by studies that involve only a small subset of patients (ie, those clinically thought to have an upper gastrointestinal neoplasm). Only a few investigations have examined the role of these paired specimens in the general patient population. Two hundred twenty-two consecutive esophageal biopsies and brushings obtained during the same endoscopic session were retrospectively reviewed. The same or a similar diagnosis was made for both specimen types in 166 (74.8%) of the specimen pairs. Among these pairs with diagnostic agreement, the most frequent diagnosis included Barrett's metaplasia (46), Candida esophagitis (37), and morphologically nonspecific inflammation (47). Nine squamous cell carcinomas and six adenocarcinomas were also detected in this subset. Diagnostic differences existed among 56 (25.2%) of the pairs. The most common diagnosis in this subset was Candida esophagitis. This fungus was present in 27 brushings, but not in the concurrently obtained biopsies. Two squamous cell carcinomas and one adenocarcinoma were diagnosed by cytology but not by biopsy. One squamous cell carcinoma was found only in the biopsy specimen. In the esophagus, brushings and biopsies are truly complementary for the detection of both neoplastic and inflammatory conditions.