CYTOLOGIC DETECTION OF ESOPHAGEAL SQUAMOUS-CELL CARCINOMA AND PRECURSOR LESIONS USING BALLOON AND SPONGE SAMPLERS IN ASYMPTOMATIC ADULTS INLINXIAN, CHINA

BACKGROUND. The principal reason for the poor prognosis of esophageal carcinoma is that most tumors are asymptomatic and go undetected until they are unresectable. Previous studies have shown that cytologic scr eening of asymptomatic high risk individuals can detect curable esopha geal carcinomas and precursor lesions, but the sensitivity of such scr eening is not well documented. The current study evaluated the sensiti vity and specificity of currently available balloon and sponge cytolog ic samplers for detecting biopsy-proven squamous dysplasia and carcino ma in asymptomatic individuals from a high risk population in Linxian, China. METHODS. Asymptomatic adults were examined with both balloon a nd sponge samplers, in random order, followed by endoscopy with mucosa l iodine staining and biopsy of all unstained lesions. The cytology sl ides were interpreted using the criteria of the Bethesda System. The b alloon and sponge cytologic diagnoses (test) were compared with the bi opsy diagnosis (truth) in each patient to estimate the sensitivity and specificity of each sampler. RESULTS. Of the 439 patients with adequa te biopsies, 123 (28%) had histologic squamous dysplasia and 16 (4%) h ad an invasive squamous carcinoma. The sensitivities/specificities of the balloon and sponge were 44%/99% and 18%/100%, respectively, for de tecting biopsy-proven squamous cell carcinoma, and 47%/81% and 24%/92% , respectively, for identifying squamous dysplasia or carcinoma. CONCL USIONS. In this study, the balloon sampler was more sensitive than the sponge sampler for detecting esophageal squamous disease, but both te chniques were less than optimal. Improved samplers and/or cytologic cr iteria should increase the sensitivities observed in this baseline stu dy. (C) 1997 American Cancer Society.