Kern E, Lin D, Larson A, Yang G-Y, Taft T, Zalewski A, Gonsalves N, Hirano I
Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Dis Esophagus. 2016 Jan;29(1):48-53. doi: 10.1111/dote.12304. Epub 2014 Dec 17.
Patients with eosinophilic esophagitis (EoE) undergo multiple endoscopies with biopsy for both diagnosis and assessment of treatment response, which is inconvenient and costly. Brush cytology has been examined in Barrett's esophagus to reduce the need for repeated endoscopic biopsies. The aim of this pilot study was to evaluate the ability of brush cytology to detect mucosal eosinophilia in patients with EoE. This prospective study included adults with untreated and treated esophageal eosinophilia undergoing endoscopy at a tertiary care center. Patients received paired brushings and biopsies at the proximal and distal esophagus. A blinded pathologist quantified the number of eosinophils and epithelial cells per high-power field (hpf) on the cytology slides. The ratio of eosinophils/epithelial cells was used to normalize the cytology specimens for density of cells collected. The main outcome measures were sensitivity and specificity of brush cytology, and correlation between cytology and histology. Twenty-eight patients enrolled. The average age of the cohort was 37.7 ± 10.4 years; 75% of subjects were male. The sensitivity of cytology was 67-69% at the proximal esophagus and 70-72% at the distal esophagus. The specificity was 61-67% proximally and 70-75% distally. Histology was not significantly correlated with the max ratio of eosinophils/epithelial cells per hpf or the absolute number of eosinophils on cytology slides. Cytology using esophageal brushing has limited sensitivity and specificity for the detection of esophageal mucosal eosinophilia. The presence of exudates on endoscopy increased the detection of eosinophilia, which could make cytology useful in pediatric EoE, which often has a more exudative presentation. Diagnostic yield may improve with alternative acquisition techniques or the incorporation of eosinophil degranulation proteins.
嗜酸性食管炎（EoE）患者需要多次进行内镜检查并活检，以用于诊断和评估治疗反应，这既不方便又昂贵。在巴雷特食管中已对刷检细胞学进行了研究，以减少重复内镜活检的需求。这项初步研究的目的是评估刷检细胞学检测EoE患者黏膜嗜酸性粒细胞增多的能力。这项前瞻性研究纳入了在三级医疗中心接受内镜检查的未经治疗和已治疗的食管嗜酸性粒细胞增多的成年人。患者在食管近端和远端接受配对的刷检和活检。一位盲法病理学家对细胞学载玻片上每个高倍视野（hpf）的嗜酸性粒细胞和上皮细胞数量进行定量。嗜酸性粒细胞/上皮细胞的比例用于对收集细胞密度的细胞学标本进行标准化。主要观察指标为刷检细胞学的敏感性和特异性，以及细胞学与组织学之间的相关性。28名患者入组。该队列的平均年龄为37.7±10.4岁；75%的受试者为男性。食管近端细胞学的敏感性为67 - 69%，远端为70 - 72%。近端特异性为61 - 67%，远端为70 - 75%。组织学与每个hpf嗜酸性粒细胞/上皮细胞的最大比例或细胞学载玻片上嗜酸性粒细胞的绝对数量无显著相关性。使用食管刷检的细胞学检测食管黏膜嗜酸性粒细胞增多的敏感性和特异性有限。内镜检查时渗出物的存在增加了嗜酸性粒细胞增多的检出率，这可能使细胞学在通常有更多渗出表现的儿童EoE中有用。采用替代采集技术或纳入嗜酸性粒细胞脱颗粒蛋白可能会提高诊断率。
