Diagnosis of upper gastro-intestinal lesions by endoscopy, cytology and biopsy.

A prospective consecutive series of 210 upper gastrointestinal endoscopic procedures, at which material for both cytological and histopathological examination was obtained, was conducted at Baragwanath Hospital. The purpose of the study was to determine the respective and combined diagnostic value of endoscopic visualization, cytological brushings and histological sections in benign and malignant lesions of the oesophagus and stomach; and in particular to assess the contribution, if any, of exfoliative cytology to the diagnostic regimen. Endoscopic visualization alone was inconclusive or incorrect in 13% of procedures, cytology alone in 9%, and biopsy alone in 12% (the latter 2 figures corrected for adequacy of material submitted). When assessed together, the diagnostic accuracy achieved by all 3 techniques was 99%. The major contribution of cytology was the correct positive diagnosis in 20% of procedures, performed on patients with malignant lesions, whose initial biopsy specimen was inadequate or normal. It is concluded that for maximal diagnostic accuracy of upper gastro-intestinal lesions, a combined approach, utilizing endoscopic examination, lesion-directed brushings and biopsy specimens, is required.