Value of brush cytology in diagnosis of gastric cancer.

Value of brush cytology in diagnosis of gastric cancer Multiple biopsies and brush cytology of gastric mucosal lesions can be performed with the fibreoptic endoscope. Though biopsy is used routinely, cytological examination of smears made from the gastric brushings has not been widely used. In a prospective study we assessed the relative value of brush cytology, multiple biopsy, and endoscopic and radiological appearances in the differentiation of benign and malignant gastric lesions in routine clinical practice in a district general hospital. Patients admitted to the study had either radiological evidence of a gastric lesion or a gastric lesion visualized at endoscopy after a negative finding on barium meal examination. Forward-or side-viewing gastroscopes were used. If a gastric ulcer was present at least four biopsy specimens were taken. The abnormal mucosa was then brushed and eight smears were made on consecutively numbered slides and fixed immediately in 95% alcohol. Smears were stained with Papanicolau stain and examined sequentially. The cytolo-gist and histopathologist were given the same clinical information about the patient, which included the endoscopist's opinion on the nature of the lesion. The results of endoscopy and histopathological and cytological examinations were independently recorded as benign, suspicious, or malignant. Altogether 134 patients with gastric lesions were admitted to the study. In 34 of the patients the diagnosis of gastric cancer was finally established either by histopathological examination of the resected specimen or by appearances at laparotomy in inoperable cases. The 100 patients with lesions judged to be benign have remained well for at least one year. Barium meal diagnosed malignancy correctly in 20 of the 34 patients (59%), gastro-scopy in 30 (880'), biopsy in 21 (62°), and cytology in 28 (820%). The table summarizes the results of the other tests in the 14 patients in whom the x-ray film raised no suspicion of malignancy. Cytology confirmed the endo-scopic diagnosis in 10 patients and in three patients was the only investigation that gave a positive result. In the 100 patients with benign gastric lesions barium meal indicated malignancy in 15. In eight no evidence of malignancy was found at endoscopy, biopsy, or brush cytology. The other seven patients were also suspected of having cancer at endoscopy but both biopsy and brush cytology were negative. Five patients with negative x-ray and biopsy findings had suspicious cytological results and in four of them cancer was also suspected at endoscopy. Partial gastrectomy in three and …