The value of brush cytology and biopsy for the diagnosis of colorectal cancer

Željka N. Tatomirović; Vesna Škuletić; Ivana Tufegdžić; Ljiljana Tomić; Jelena Džambas; Dino Tarabar

doi:10.2298/VSP160112115T

Željka N. Tatomirović Military Medical Academy, Institute of Pathology and Forensic Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Vesna Škuletić Military Medical Academy, Institute of Pathology and Forensic Medicine; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
Ivana Tufegdžić Military Medical Academy, Institute of Pathology and Forensic Medicine; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia.
Ljiljana Tomić Military Medical Academy, Institute of Pathology and Forensic Medicine.
Jelena Džambas Military Medical Academy, Institute of Pathology and Forensic Medicine.
Dino Tarabar Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia; Military Medical Academy, Clinic for Gastroenterology and Hepatology, Belgrade, Serbia.

DOI: https://doi.org/10.2298/VSP160112115T

Keywords: colorectal neoplasms, adenocarcinoma, diagnosis, biopsy, cytological techniques, sensitivity and specificity,

Abstract

Background/Aim. Although it is well-known the high sensitivity of brush cytology for the diagnosis of colorectal adenocarcinoma, this kind of diagnostics is not routinely used, and for the past years it has even been declining. The purpose of this study was to evaluate the value of brush cytology for the diagnosis of colorectal carcinoma, by comparison the results of brush cytology and biopsy, and then the results of both diagnostic methods with the final patohistological diagnosis of colorectal resection. Methods. This retrospective study included 173 patients with brush cytology of colorectal region during colonoscopy. In 166 patients concomitant biopsy specimens were obtained, and in 116 of them resection of the intestine as well. A total of the 106 patients underwent to all three diagnostic procedures. Results. Out of 166 patients who went through both brush cytology and biopsy, the congruent diagnosis was made in 129 (77.7%) patients: in 109 (65.7%) adenocarcinoma was diagnosed, which was confirmed after the resection of the intestine in 75 of the patients, and in 14 (8.4%) benign lesion, so there was no need for resection of the intestine. In 6 (3.6%) of the patients, both cytology and biopsy were negative, but the resected specimen was malignant. In 10 of the patients with malignant cytology in whom biopsy was not done, resection of the intestine confirmed malignancy. The sensitivity of detecting malignancy by brush cytology and biopsy were 87.9% and 78.3%, respectively (but this difference was not statistically significant, p = 0.083). Both methods had specificity and positive predictive values 100%. Negative predictive values for cytology and biopsy were 50% and 37.8%, respectively. The accuracy of cytology and biopsy was 89.2% and 80.8%, respectively. The combination of the results of brush cytology and biopsy increased the sensitivity of preoperative diagnostics to 94.8% which was significantly higher than sensitivity of biopsy (p < 0.001), but not than sensitivity of cytology (p = 0.102). Conclusion. Brush cytology could be a routine method, along with biopsy, in the diagnosis of colorectal malignancy. Both methods have comparable both sensitivity and accuracy, and its combination increases sensitivity of preoperative diagnostics of colorectal adenocarcinoma, which gives opportunity to better estimation of further diagnostic and therapeutic approach.

Author Biography

Željka N. Tatomirović, Military Medical Academy, Institute of Pathology and Forensic Medicine, Belgrade, Serbia; University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

Department of cytology

References

Ferlay J, Soerjomataram I, Ervik M, Dikshit R, Eser S, Mathers C, et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No 11. Lyon, France: Interna-tional Agency for Research on Cancer; 2013.

Vlajinac H, Sipetić-Grujicić S, Janković S, Marinković J, Kocev N, Marković-Denić L, et al. Burden of cancer in Serbia. Croat Med J 2006; 47(1): 134−41.

Wisseman CL Jr, Lemon HM, Lawrence KB. Cytologic diagnosis of cancer of the descending colon and rectum. Surg Gynecol Obstet 1949; 89(1): 24−30.

Schmitt F, Oliveira MH. Oesophagus and gastrointestinal tract. In: Gray W, Kocjan G, editors. Diagnostic cytopathology. Lon-don: Churchill Livingstone Elsevier; 2010. p. 279−81.

Cardoso L. Cytology of colorectal carcinoma In: Welvaart K, Blumgart LH, Kreuning J, editors. Colorectal Cancer. Hague: Leiden University Press; 1980. p. 43−52.

Vander Noot MR 3rd, Eloubeidi MA, Chen VK, Eltoum I, Jhala D, Jhala N, et al. Diagnosis of gastrointestinal tract lesions by en-doscopicultrasound-guided fine-needle aspiration biopsy. Cancer 2004; 102(3): 157−63.

Fernández-Esparrach G, Alberghina N, Subtil JC, Vázquez-Sequeiros E, Florio V, Zozaya F, et al. Endoscopic ultrasound-guided fine needle aspiration is highly accurate for the diagnosis of perirectal recurrence of colorectal cancer. Dis Colon Rectum 2015; 58(5): 469−73.

Kontzoglou K, Moulakakis KG, Alexiou D, Safioleas MC, Nikiteas N, Giahnaki A, et al. The role of liquid-based cytology in the investigation of colorectal lesions: A cytohistopathological cor-relation and evaluation of diagnostic accuracy. Langenbecks Arch Surg 2007; 392(2): 189−95.

Farouk R, Dodds J, MacDonald AW, Young W, Duthie GS, Lee PW, et al. Feasibility study for use of brush cytology as a com-plementary method for diagnosis of rectal cancer. Dis Colon Rectum 1997; 40(5): 609−13.

Halpern M, Gal R, Rath-Wolfson L, Koren R, Weil R, Avni A. Brush cytology and biopsy in the diagnosis of colorectal can-cer. A comparison. Acta Cytol 1997; 41(3): 628−32.

Petrelli NJ, Létourneau R, Weber T, Nava ME, Rodriguez-Bigas M. Accuracy of biopsy and cytology for the preoperative diagnosis of colorectal adenocarcinoma. J Surg Oncol 1999; 71(1): 46−9.

Geramizadeh B, Hooshmand F, Kumar PV. Brush Cytology of Co-lorectal Malignancies. Acta Cytol 2003; 47(3): 431−4.

Brouwer R, MacDonald A, Matthews R, Gunn J, Monson JR, Hartley JE. Brush cytology for the diagnosis of colorectal cancer. Dis Colon Rectum 2009; 52(4): 598−601.

Ehya H, O'Hara BJ. Brush cytology in the diagnosis of colonic neoplasms. Cancer 1990; 66(7): 1563−7.

MacDonald AW, Tayyab M, Arsalani-Zadeh R, Hartley JE, Monson JR. Intramucosal carcinoma on biopsy reliably predicts inva-sive colorectal cancer. Ann Surg Oncol 2009; 16(12): 3267−70.

Wei XB, Gao XH, Wang H, Fu CG, Zheng WQ, Zheng JM, et al. More advanced or aggressive colorectal cancer is associated with a higher incidence of "high-grade intraepithelial neopla-sia" on biopsy-based pathological examination. Tech Colo-proctol 2012; 16(4): 277−83.

Kini SR. Alimentary tract: Esophagus, gastrointestinal, gall bladder and extrahepatic biliary tract (Exfoliative and aspira-tion cytology). In: Kini SR, editor. Color atlas of differential di-agnosis in exfoliative and aspiration cytopathology. Baltimore: Lippincott Williams&Wilkins; 2011. p. 305−7.

Yu GH, Nayar R, Furth EE. Adenocarcinoma in colonic brushing cytology: High-grade dysplasia as a diagnostic pitfall. Diagn Cytopathol 2001; 24(5): 364−8.

Hamilton SR, Aaltonen LA. World Health Organisation classifi-cation of tumors: Pathology and genetics of tumours of the digestive system. Lyon: IARC Press; 2000.

Technology Assessment Committee, Barkun A, Liu J, Carpenter S, Chotiprasidhi P, Chuttani R, et al. Update on endoscopic tissue sampling devices. Gastrointest Endosc 2006; 63(6): 741−5.

Conrad R, Castelino-Prabhu S, Cobb C, Raza A. Role of cytopa-thology in the diagnosis and management of gastrointestinal tract cancers. J Gastrointest Oncol 2012; 3(3): 285−98.

Schlemper RJ, Itabashi M, Kato Y, Lewin KJ, Riddell RH, Shimoda T, et al. Differences in the diagnostic criteria used by Japanese and Western pathologists to diagnose colorectal carcinoma. Cancer 1998; 82(1): 60−9.

Schlemper RJ, Riddell RH, Kato Y, Borchard F, Cooper HS, Dawsey SM, et al. The Vienna classification of gastrointestinal epithelial neoplasia. Gut 2000; 47(2): 251−5.

Dixon MF. Gastrointestinal epithelial neoplasia: Vienna revi-sited. Gut 2002; 51(1): 130−1.

Tominaga K, Fujinuma S, Endo T, Saida Y, Takahashi K, Maetani I. Efficacy of the revised Vienna Classification for diagnosing colorectal epithelial neoplasias. World J Gastroenterol 2009; 15(19): 2351−6.