Serial fine needle cytology in the diagnosis of esophageal cancer.
OBJECTIVE
To describe a method of registering local spread of cancer in the esophageal wall through serial endoscopic fine needle aspiration (FNA), to evaluate FNA as a diagnostic tool as compared to histologic biopsies and brush cytology, and to investigate cytologic appearances of aspirates and correlate them with survival


METHODS
Fifty-two patients with esophageal cancer were investigated with serial FNA every second centimeter from the upper esophageal sphincter aborally down to the level of macroscopic tumor. Histologic biopsies and brush cytologies were then performed.


RESULTS
Of investigated cases, 33% showed malignant or suspect malignant cells from macroscopic tumor, at > or = 4 cm orally, as did 3 of 12 patients at 14 cm. FNA was more sensitive than brush cytology in establishing the diagnosis. A high ratio between the numbers of benign and malignant cells in aspirates from gross tumor tissue correlated with shorter survival (P < .03).


CONCLUSIONS
Serial FNA can demonstrate local microscopic tumor spread in the wall of the esophagus in vivo in esophageal cancer patients. FNA is also a useful adjunct in establishing the diagnosis. Finally, evaluations of tumor cytology may have prognostic value.
Stockeld
Dag
D
Department of Surgery, Karolinska Institutet, Danderyd Hospital, S-182 88 Danderyd, Sweden. stockeld@ebox.tninet.se
Ingelman-Sundberg
Henrik
H
Granström
Lars
L
Fagerberg
Jan
J
Backman
Lars
L
D000230:Adenocarcinoma / Q000473:pathology* / Q000556:secondary; D001706:Biopsy; D001707:Biopsy, Needle / Q000009:adverse effects / Q000379:methods*; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000556:secondary; D004938:Esophageal Neoplasms / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011379:Prognosis; D012680:Sensitivity and Specificity