Endoscopic techniques in the diagnosis of upper gastrointestinal tract malignancies. A comparison.

OBJECTIVE To perform a comparative evaluation of various endoscopic techniques in the diagnosis of upper gastrointestinal tract malignancies. STUDY DESIGN Thirty cases of suspected malignancy involving the upper gastrointestinal tract were studied. In all 30 cases, four endoscopic cytology techniques (brushing before biopsy, brushing after biopsy, fine needle aspiration cytology [FNAC] and suction cytology) were evaluated and correlated with histology by forceps biopsy. All the cytologic techniques were used and forceps biopsy carried out in a single sitting, but the forceps biopsy was repeated in 4 of 30 cases. RESULTS The respective positive yields of brushing before biopsy, brushing after biopsy, FNAC, suction cytology and forceps biopsy were 80.0%, 86.6%, 83.3%, 76.6% and 90.0%. When two cytologic techniques were combined, 100% accuracy was obtained by brushing after biopsy and FNAC and brushing before biopsy and suction cytology. CONCLUSION Brushing cytology is a sensitive diagnostic test, and the combined use of biopsy and brushing offers the highest probability of identifying malignancy.