Cyto Histological Correlation of Brush Cytology with Biopsy in Upper GI Lesions

Abstract

Neoplasms of upper gastrointestinal tract specially malignancy is one of the leading causes of death worldwide. Endoscopy has greatly facilitated the detection and diagnosis of gastrointestinal lesions. Early cancer is highly curable. Unfortunately most early cancers are asymptomatic. Brush cytology and biopsy are complimentary procedures for the detection of upper gastrointestinal neoplasms. 100 cases of non-neoplastic and neoplastic lesions were studied over a period of one year from January 2015 to December 2015 at the Department of Pathology, Gandhi Hospital/Medical College, Hyderabad, Telangana, India. Patients between 21 to 75 years of age presenting to the department of Gastroenterology with complaints of dysphagia, retrosternal pain, vomiting and loss of weight were included in the study. Endoscopy was done using flexible video endoscopy on patients with ulcer or polypoid and ulcerative growths in the upper GIT. Exfoliated cells from the lesion were collected by means of a brush introduced through the endosope. Smears were made by directly smearing the brush on to a slide and fixed with a spray fixative containing 95% ethyl alcohol. Slides were stained by Hematoxylin & Eosin and Papanicoulou stains. After brushing, multiple biopsies were taken from the representative area of the lesions. Cytohistological correlation was done. Brush cytology is a useful, inexpensive procedure that gives rapid diagnosis in cases of endoscopically visible suspicious lesions of upper GIT. It is an accurate diagnostic adjunct to biopsy in the detection of cancers at an early stage.

Diagnostic utility of endoscopic brush cytology in upper gastrointestinal malignancies

“…In our study, majority of patients were in the age group of 41‐60 years with the mean age being 58 years. This is comparable to other studies conducted by Vidyavathi et al, 4 Kaur et al, 5 Devi et al, 11 Hammadi et al, 12 Batra et al, 13 and Ojha et al 14 in which mean age ranged from 50 to 60 years.…”

“…Statistical analysis revealed the overall sensitivity of brush cytology in this study to be 84.4% which emphasizes the usefulness of brush cytology as a screening procedure. The sensitivity of this study is comparable to studies of Kaur et al 5 having the diagnostic sensitivity of 80.95%, Ojha et al 14 having diagnostic sensitivity of 78.07%, Hammadi et al 12 with 94%, Vidyavathi et al 4 having 98%, Devi et al 11 with 90%, Batra et al 13 having diagnostic sensitivity of 89.71%. O'Donoghue et al, 15 in their study, found that with additional use of cytology, the sensitivity increased from 83.5% to 97.5% and hence cytology is a useful adjunct in patients with suspicious mucosal lesions.…”

“…Vidyavathi et al, 4 however, reported predominance of gastric lesions in her study (64%) followed by esophageal (30.66%) and duodenal (5.33%) lesions. Devi et al 11 also reported predominance of gastric lesions (50%) in her study followed by esophagus in 34% cases and duodenum in 16% cases. This difference is attributed to various studies being carried in different geographical areas with wide differences in habits of the people living in these areas.…”

“…This ratio is in conformity with findings of Kaur et al 5 and Vidawati 4 who reported a ratio of 2.5:1 and 1.7:1, respectively. Ojha et al 14 reported this ratio to be 1.74:1, Batra et al 13 1.4:1, Devi et al 11 4:1, and Karmarkar et al 9 reported this ratio to be 3:2. This small variation is due to variation in the selection of the study group.…”