Primary Motility  Disorders of the  Esophagus
 The Esophageal
 Esophagogastric  Junction

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Volume: Barrett's Esophagus
Chapter: Dysplasia

Should cytology-based clinical decisions always be complemented by correlative results from biopsies?

H.H. Wang (Boston)

Cytology clearly can detect significant lesions that are missed on biopsy. Whether clinical decisions can be based on cytological diagnosis alone depends on a number of factors. The first is the degree of certainty of the cytological diagnosis and/or confirmation by an experienced cytopathologist. If the cytological diagnosis is firm and confirmed, it can serve as a guide to clinical decisions without a biopsy or a correlative biopsy result. If the cytological diagnosis is less than definitive, then the next step should depend on whether there is corroborating endoscopic/clinical evidence to support the cytological diagnosis/suspicion and on the ease with which to obtain a biopsy. It is always a good idea to confirm the cytological and/or clinical suspicion with a biopsy unless there is contraindication or difficulty of a biopsy procedure, such as bleeding tendency or stenosis to prevent the passage of an endoscope or biopsy forceps.

Another consideration is the implication of any potential differential diagnosis of the cytological diagnosis. For example, if the diagnosis is dysplasia (carcinoma in situ) and the differential diagnosis is invasive carcinoma or vice versa, a biopsy may be irrelevant if both dysplasia and carcinoma will be treated with resection. However, a biopsy result would be crucial if carcinoma indicates a resection and dysplasia means follow-up. Cytology is very limited, if not impossible, in making such a fine distinction. Architecture, which is best appreciated on histology, is essential in this case.

In summary, it is not necessary to always complement the cytology-based clinical decisions with correlative biopsy results, especially when the cytology diagnosis is firm, confirmed, and corroborated by clinical evidence.

Publication date: August 2003 OESO©2015