The endoscopic diagnosis of gastroesophageal malignancy. A cytologic review.
Cytologic reports were compared to final diagnoses for 1,157 gastroesophageal samples from an eight-year period in order to evaluate the diagnostic accuracy of endoscopic cytology and to determine the significance of a "suspicious" cytologic report. In the subgroup of patients with adenocarcinoma evaluated by paired endoscopic biopsy and cytology, the relative and combined sensitivities of the sampling methods were studied. Cytologic examination was reported as positive or suspicious in 85% of 229 cases of malignancy. There were three false-positive diagnoses of squamous-cell carcinoma of the esophagus, representing 0.3% of all submitted samples. Suspicious cytologic reports were issued in 5% of all cases. The majority (63%) of patients with a suspicious cytologic report had a final diagnosis of malignancy, with gastric adenocarcinoma present in almost half of the cases. Adenocarcinoma was diagnosed in 168 of the patients. Combined endoscopic biopsy and cytology was more sensitive (96%) than biopsy alone (90%) in making the initial diagnosis. Cytology may be of particular value in the diagnosis of gastroesophageal malignancy when the lesions are small and superficial or where stricture precludes adequate biopsy. Regardless of the biopsy findings, patients with "suspicious" cytologic reports require careful reevaluation since a high percentage of those cases in our series were subsequently verified as having malignancy.