Endoscopic biopsy and cytology in the diagnosis of malignant gastric ulcers.

Endoscopy significantly improves the diagnosis of tumors of the stomach; however, its value may be limited in differentiating benign from malignant gastric ulcers (MGUs). The accuracy of endoscopy was compared in 20 patients with MGU studied by endoscopy, biopsy, and cytology. Endoscopy correctly diagnosed 13 cases (65%), with endoscopic signs being benign or indeterminate in the remaining seven. However, all 20 MGUs were accurately diagnosed since biopsy and cytology increased the diagnostic accuracy of endoscopy in the remaining seven patients. The combination of biopsy and cytology yielded a positive diagnosis in 19 patients (95%); the remaining patient was operated on with only the endoscopic diagnosis of MGU. The complementarity of these three techniques was highlighted in five cases where only one of the procedures unequivocally diagnosed malignancy. It is concluded that biopsy and cytology are useful complementary techniques and should always be performed together in categorizing the nature of all gastric ulcers despite a benign macroscopic appearance at endoscopy.

Exfoliative cytodiagnosis of gastric adenocarcinoma. Comparison with biopsy and endoscopy.

Endoscopy complemented by directed biopsies and exfoliative cytology was performed on 593 patients with different gastric lesions. Of the 194 cases of proven adenocarcinoma of the stomach, cytology was positive for malignancy in 176 (90.7%) and yielded the highest diagnostic rate. Endoscopy correctly diagnosed 171 cases (88.1%), and biopsy had the lowest accuracy, 153 cases (78.9%). The combined use of the three techniques increased the positive diagnosis to 185 adenocarcinomas (95.4%). Only three early gastric cancers were diagnosed by the combined methods, with only cytology positive in all three cases. There were five (1.3%) false-positive cytologic reports, principally due to benign gastric ulcers. It is concluded that these techniques have a complementary function in distinguishing benign from malignant gastric lesions. Since the value of endoscopic signs is limited, biopsy and cytology should always be performed. Exfoliative cytology plays an effective diagnostic role in cancer of the gastrointestinal tract and should be used more frequently by gastroenterologists, who, however, should be aware of the risk of false-positive results.

Correlations between ldh isoenzyme patterns and brushing cytology in ulcerative colitis.

Forty-one rectal samples from 22 patients with ulcerative colitis and eight rectal samples from normal controls were studied cytologically, histologically and histochemically (LDH isoenzyme pattern). The cytological specimens from patients were classified into three groups (A, B and C) and the degree of cellular atypia was compared with the modifications of LDH isoenzymogram. The differences between the polypeptide M levels of the group A, B and C were statistically significant, as well as those between groups B and C versus the normal controls. The highest percentages of M were observed in group C and correlate with the presence of large single or double nucleoli. These results most likely represent active cellular regeneration, and further investigations are needed to elucidate whether the histochemical alterations could be useful to detect precocious malignant changes in patients with long-standing ulcerative colitis.