Cytologic Study For Endoscopic Diagnosis Of Colorectal Cancer

Aim: to prospectively assess the usefulness of cytologic study for endoscopic diagnosis of colorectal cancer (CRC). Materials and Methods: All patients with endoscopic diagnosis of CRC between April 2002 and August 2003 were taken both a cytology sample and biopsy samples from the tumor. To obtain the cytolgy sample, a cytology brush CCB 7-240-3-S (Cook) was used. For biopsies, we used a Radial-Jaw biopsy probe (240-2, 2-2, 8 Boston Scientific). In all cases, for cytologic examination two air-dried extensions were sent to laboratory as well as a tube containing material from final brush lavage in ethanol 96°. One of the extensions was processed by fast-dying (diff-Quick, rapid Panoptic); the second extension was re-hydrated with glycerol and saline serum and fixed in ethanol 96° for Papanicolaou dying. The material in the tube was centrifuged at 2500 rpm for 10'. After, if a sediment was visible, 2 extensions were made and Papanicolaou-dyed; if a sediment was not visible, a 3-minute cytocentrifugation was performed and the subsequent extensions were treated as previously described. Biopsies were processed according to the usual hematoxilin-eosin technique. Results: 70 patients diagnosed of CRC were included (44 colon, 26 rectum). In all cases this diagnosis was confirmed by surgical specimen pathologic examinaton (51 cases) or by endoscopic biopsy examination (remaining 19 patients). 69 were adenocarcinoma (AC); the remaining case was a gastrointestinal stromal tumor (GIST). Cytology was positive in 68 cases, and there were 2 false-negative cytologic results: the GIST case and 1 rectal AC later confirmed by biopsy. In no case cytologic sample was considered technically inadequate for diagnostic examination. Biopsies (median 3 per lesion, range 2-5). were positive in 60 cases; in the remanining 10 cases (9 AC, 1 GIST) biopsy diagnosis was normal colonic tissue (6 cases), chronic nonspecific colitis (1 case), fecaloid material (1 case), and adenoma (2 cases). Sensitivity for diagnosis of CRC was 100% for endoscopic examination, 97.1% for cytology, and 85.7% for biopsy. Cost of biopsy was double than that of cytology. Conclusions: Cytologic examination for diagnosis of CRC has several advantages compared to biopsy: it is easier and faster to perform during the endoscopic procedure and to process and examine in the pathology lab, it has higher sensitivity, and it is cheaper. Aim: to prospectively assess the usefulness of cytologic study for endoscopic diagnosis of colorectal cancer (CRC). Materials and Methods: All patients with endoscopic diagnosis of CRC between April 2002 and August 2003 were taken both a cytology sample and biopsy samples from the tumor. To obtain the cytolgy sample, a cytology brush CCB 7-240-3-S (Cook) was used. For biopsies, we used a Radial-Jaw biopsy probe (240-2, 2-2, 8 Boston Scientific). In all cases, for cytologic examination two air-dried extensions were sent to laboratory as well as a tube containing material from final brush lavage in ethanol 96°. One of the extensions was processed by fast-dying (diff-Quick, rapid Panoptic); the second extension was re-hydrated with glycerol and saline serum and fixed in ethanol 96° for Papanicolaou dying. The material in the tube was centrifuged at 2500 rpm for 10'. After, if a sediment was visible, 2 extensions were made and Papanicolaou-dyed; if a sediment was not visible, a 3-minute cytocentrifugation was performed and the subsequent extensions were treated as previously described. Biopsies were processed according to the usual hematoxilin-eosin technique. Results: 70 patients diagnosed of CRC were included (44 colon, 26 rectum). In all cases this diagnosis was confirmed by surgical specimen pathologic examinaton (51 cases) or by endoscopic biopsy examination (remaining 19 patients). 69 were adenocarcinoma (AC); the remaining case was a gastrointestinal stromal tumor (GIST). Cytology was positive in 68 cases, and there were 2 false-negative cytologic results: the GIST case and 1 rectal AC later confirmed by biopsy. In no case cytologic sample was considered technically inadequate for diagnostic examination. Biopsies (median 3 per lesion, range 2-5). were positive in 60 cases; in the remanining 10 cases (9 AC, 1 GIST) biopsy diagnosis was normal colonic tissue (6 cases), chronic nonspecific colitis (1 case), fecaloid material (1 case), and adenoma (2 cases). Sensitivity for diagnosis of CRC was 100% for endoscopic examination, 97.1% for cytology, and 85.7% for biopsy. Cost of biopsy was double than that of cytology. Conclusions: Cytologic examination for diagnosis of CRC has several advantages compared to biopsy: it is easier and faster to perform during the endoscopic procedure and to process and examine in the pathology lab, it has higher sensitivity, and it is cheaper.