CYTOLOGIC CRITERIA FOR THE BRUSH DIAGNOSIS OF GASTRIC ADENOCARCINOMA

BACKGROUND, The cytologic diagnosis of gastric adenocarcinoma often is difficult, and the role of gastric brushing in the detection of gastr ic malignancy is controversial. The purpose of this study was to ident ify the key cytologic criteria that are most useful for establishing a diagnosis of adenocarcinoma in gastric brushing specimens. METHODS. O ne hundred gastric brushings were reviewed retrospectively. Fifty of t he specimens were obtained from patients with histologically confirmed benign lesions. The other 50 specimens were obtained from patients wi th histologically confirmed gastric adenocarcinoma. AU 100 brushing sp ecimens were reviewed without knowledge of the histologic diagnosis. E ach specimen was assessed for the presence or absence of 16 different cytologic features that have been identified in the published literatu re as being useful for separating benign conditions from malignancy. A multiple logistic linear regression analysis was performed to deter m ine which combination of criteria was the most useful for diagnosing g astric adenocarcinoma. RESULTS. Three key cytologic criteria were iden tified as being the most useful for diagnosing gastric adenocarcinoma: single atypical cells with intact cytoplasm, eccentric nuclei, and at ypical naked nuclei. When at least 2 of these cytologic criteria were present, the sensitivity and specificity for detecting adenocarcinoma were 88% and 100%, respectively. Two minor cytologic criteria also wer e identified: nuclear hyperchromasia and nuclear molding. CONCLUSIONS. Our statistical analysis demonstrates that gastric adenocarcinoma can be diagnosed with a high degree of accuracy using gastric brushing sp ecimens when specific cytologic criteria are applied. Cancer (Cancer C ytopathol) 1998;84:289-94. (C) 1998 American Cancer Society.