Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Esophagogastric  Junction

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Volume: Barrett's Esophagus
Chapter: Dysplasia

Are there data indicating that brush cytology is a valuable aid in the detection of high-grade dysplasia that is missed on biopsy?

H.H. Wang (Boston)

Although it has been well documented that the combined use of endoscopic biopsy and brushing cytology is more sensitive than either one alone in evaluating upper gastrointestinal tract lesions [1-3] very few studies have specifically compared the diagnostic yield of biopsy versus cytology for dysplasia in Barrett's esophagus, let alone high-grade dysplasia [4]

As a principle, any increase in sampling improves the probability of correctly identifying the lesion. In particular, cytological sampling subjects a much greater area of mucosal surface to examination than can be achieved with random or directed mucosal biopsies. Therefore, cytology revealed a higher grade lesion in 13 cases than did histology (while biopsy revealed a higher grade lesion than cytology in five) in one study [5] and identified two more cases of low-grade dysplasia (LGD) than histology in another study [6]. In the former study, two cases of dysplasia, one case of carcinoma, and five cases of suspicious (reactive versus dysplasia) were diagnosed on cytology while the corresponding biopsy diagnoses were benign Barrett's esophagus in all [5] (Table I). In addition, five cases of carcinoma were diagnosed on cytology with the diagnosis on biopsy being dysplasia. (Table I) Four esophagogastrectomy procedures were performed with discrepant preoperative biopsy-cytology diagnosis. All four had carcinoma on cytology, while two had dysplasia and two had benign Barrett's esophagus on biopsy. Biopsy was correct in the two cases of (high-grade) dysplasia, and cytology was correct in the other two (carcinoma). (Table II) In the other study [6], no dysplasia was missed on cytology and one of the two cases of LGD identified on cytology alone was confirmed on biopsy in a subsequent endoscopy.

Table I. Comparison of paired biopsy-cytology diagnosis (n = 64) (from [5]).

Table II. Follow-up of four cases with discrepant biopsy-cytology diagnosis that had esophagogastrectomy procedures performed (from [5]).

In summary, cytology is valuable in the detection of significant lesions that are missed on biopsy. However, cytology may not be as accurate as biopsy in the precise grading/classification of the lesion.


1. Wang HH, Jonasson JG, Ducatman BS. Brushing cytology of the upper gastrointestinal tract. Obsolete or not? Acta Cytol 1991;35:195-198.

2. Geisinger KR. Endoscopic biopsies and cytologic brushings of the esophagus are diagnostically complementary. Am J Clin Pathol 1995;103:295-299.

3. O'Donoghue JM, Horgan PG, O'Donohoe MK, et al. Adjunctive endoscopic brush cytology in the detection of upper gastrointestinal malignancy. Acta Cytol 1995;39:28-34.

4. Hughes JH, Cohen MB. Is the cytologic diagnosis of esophageal glandular dysplasia feasible? Diagn Cytopathol 1998;18:312-316.

5. Geisinger KR, Teot LA, Richter JE. A comparative cytopathologic and histologic study of atypia, dysplasia, and adenocarcinoma in Barrett's esophagus. Cancer 1992;69:8-16.

6. Wang HH, Sovie S, Zeroogian JM, Spechler SJ, Goyal RK, Antonioli DA. Value of cytology in detecting intestinal metaplasia and associated dysplasia at the gastroesophageal junction. Hum Pathol 1997;28:465-471.

Publication date: August 2003 OESO©2015