Padmavathy Femila, Siddaraju Neelaiah, Sistla Sarath Chandra
Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India.
Diagn Cytopathol. 2011 Jan;39(1):60-4. doi: 10.1002/dc.21379.
Although debatable, role of cytology in diagnosing Barrett's esophagus has been stressed by some authors. Our brief report analyses the role of brush cytology (BC) in its diagnosis. Eight patients who presented with upper gastrointestinal (GI) manifestations and subsequently diagnosed to have Barrett's esophagus with or without adenocarcinoma on brush cytology (BC) or, endoscopic biopsy (EB) or, a combination of both the techniques were included in the study. In all the cases routine cytologic smears and histologic sections with relevant special stains (when essential) were studied. On cytology, the diagnosis of "Barrett's esophagus" was made when the esophageal brushings obtained from a region beyond 3 cm from the gastroesophageal junction showed closely intermingled clusters of squamous and columnar cells, or when there was evidence of intestinal metaplasia. Adenocarcinoma in Barrett's esophagus was diagnosed by the usual criteria for malignancy with features of adenocarcinoma. Cytologic diagnoses were correlated with the histologic diagnoses. Of the eight cases, seven had histopathologic correlation of which six had evidence of BE on BC; four had cytohistologic concordance, of which three cases revealed adenocarcinoma arising in BE. Two endoscopic biopsies were nonrepresentative. In one case, cytology missed Barrett's esophagus. For two cases in which cytology detected Barrett's mucosa, biopsies were nonrepresentative. Our study showed brush cytology (BC) to be a fairly reliable test for detecting Barrett's esophagus. Owing to its inherent advantage of sampling a wider and circumferential area, a technically well performed brushing procedure is likely to be more representative and superior than multiple endoscopic biopsies.
尽管存在争议，但一些作者强调了细胞学在诊断巴雷特食管中的作用。我们的简短报告分析了刷检细胞学（BC）在其诊断中的作用。本研究纳入了8例出现上消化道（GI）症状，随后经刷检细胞学（BC）、内镜活检（EB）或两者结合诊断为伴有或不伴有腺癌的巴雷特食管患者。在所有病例中，均对常规细胞学涂片和相关特殊染色（必要时）的组织学切片进行了研究。在细胞学检查中，当从距胃食管交界处3 cm以外区域获取的食管刷片显示鳞状细胞和柱状细胞紧密混合成团，或有肠化生证据时，诊断为“巴雷特食管”。巴雷特食管腺癌根据腺癌特征的常规恶性标准进行诊断。细胞学诊断与组织学诊断相关。8例患者中，7例有组织病理学相关性，其中6例在BC上有巴雷特食管证据；4例细胞组织学一致，其中3例显示腺癌起源于巴雷特食管。2例内镜活检不具代表性。1例中，细胞学检查漏诊了巴雷特食管。对于2例细胞学检查发现巴雷特黏膜的病例，活检不具代表性。我们的研究表明，刷检细胞学（BC）是检测巴雷特食管的一项相当可靠的检查。由于其在更广泛和圆周区域取样的固有优势，技术操作良好的刷检程序可能比多次内镜活检更具代表性且更优越。
