Histology vs Brush Cytology (BC) in the Diagnosis and Follow Up of Barrett's Esophagus (BE)

Abstract

Background and Aim. BE is a known preneoplastic condition. Estimated incidence of esophageal adenocarcinoma ranges between 0.45 and 1.2%. Pts. need periodic endoscopic surveillance, with histologic sampling, as early detection of esophageal neoplasia can lead to effective treatment. However, 4-quadrant biopsies protocols suffer limited accuracy. For this reason, additional techniques have been investigated to improve overall accuracy, including BC. To date, there are scant data about the role of BC in the screening of BE. Aim of this study was to investigate the diagnostic value of BC for detection of BE, dysplasia and carcinoma. Methods: We compared the results of esophageal biopsies and BC obtained during the same endoscopic examination, performed in all pts. suspected of having BE (September 2002-October 2004). Histology protocol: four-quadrant biopsies at 1-cm intervals, starting from the esophago-gastric junction. Biopsies were stained with hematoxylin-eosin, PAS-diastase, and Giemsa staining. BC protocol: vigorous 90-second rubbing on all areas of endoscopic suspicion of BE. Cytologic material was stained with Papanicolau staining. One pathologist performed all the analyses. Results: Forty-five consecutive patients (7F:38M; median age 54 yrs., range 26-76 yrs.) with endoscopic suspicion of BE underwent both histologic sampling and BC. BE extension range was 1-6 cm, mean 2 cm. At histology, 43 patients had BE, 6 had low grade dysplasia, 1 had high grade dysplasia, and 1 had adenocarcinoma. At cytology, 28 patients had BE, 2 had low grade dysplasia, 2 had high grade dysplasia and 1 had adenocarcinoma. Only 2 pts. presented BE at BC but not at histology; additionally, 1 pt. presented low grade dysplasia and 1 pt. presented high grade dysplasia at BC but not at histology. Two pts. with adenocarcinoma, one with positive histology and negative BC, and one with positive BC and negative histology, were identified. Sensitivity of histology and BC for detecting BE was 95.5% and 62.2%, respectively; sensitivity for detecting low grade dysplasia was 85% and 28.5%, respectively. Conclusions: The cytologic differentiation among low and high grade dysplasia and adenocarcinoma was difficult. However, although histology showed a superior ability compared to cytology to detect preneoplastic evolution of BE, in our study, the combination of both techniques turn out to have a complementary diagnostic yield. However more studies on larger number of patients are needed.