Usefulness of cytopathology and histology in the evaluation of Barrett's esophagus in a community hospital.
BACKGROUND
Brush cytology and histology have been found to be complementary in the evaluation of Barrett's esophagus at a referral medical center. This study evaluated the usefulness of brush cytology and histology in a community hospital setting.


METHODS
One hundred consecutive patients with Barrett's esophagus underwent esophagogastroscopy performed by four staff gastroenterologists. Four quadrant biopsy specimens for histopathology at 3-cm intervals throughout the Barrett's segment and one brushing for cytology were obtained. All specimens were interpreted by four board-certified staff pathologists in a blinded fashion.


RESULTS
Histologic diagnosis included three adenocarcinomas, one high-grade dysplasia, six low-grade dysplasias, and one indeterminate dysplasia. Cytology diagnosed the same three adenocarcinomas, no high-grade dysplasia, three low-grade dysplasia, and two indeterminate dysplasias. The case of high-grade dysplasia on histology was diagnosed as normal by cytology. The six patients found to have low-grade dysplasia by histology were found to have low-grade dysplasia (3), indeterminate dysplasia (2), and no abnormality (1) by cytology. In no case was a higher grade of dysplasia diagnosed by cytology than by histology.


CONCLUSIONS
Adding brush cytology to histology increased the cost but not the diagnostic yield in the evaluation of Barrett's esophagus in a community hospital setting.
Alexander
J A
JA
Department of Gastroenterology, Burns Clinic Medical Center, Petoskey, Michigan 49770, USA.
Jones
S M
SM
Smith
C J
CJ
Doull
J A
JA
Gietzen
T H
TH
Rathgaber
S W
SW
D000230:Adenocarcinoma / Q000473:pathology; D001471:Barrett Esophagus / Q000473:pathology*; D001706:Biopsy; D003365:Costs and Cost Analysis; D046508:Culture Techniques; D003937:Diagnosis, Differential; D004938:Esophageal Neoplasms / Q000473:pathology; D004945:Esophagoscopy; D004947:Esophagus / Q000166:cytology / Q000473:pathology; D006652:Histological Techniques / Q000191:economics; D006764:Hospitals, Community; D006801:Humans; D015588:Observer Variation; D012680:Sensitivity and Specificity