Howard F. Raskin

Exfoliative cytology in diagnosis of cancer of the colon

THE GREAT ?~IAJORITY Of adenocarcinomas of the colon can be identified and diagnosed by exfoliative cytology. The diagnostic accuracy of this method when appl ied to the colon is equivalent to that of the esophagus and stomach. One wonders why it has not been used as frequently by the cytopathologist in diagnosing cancer of the colon as he has cancer of other areas of the gastro-intestinal tract where the curabil i ty rate is decidedly lower. Probably the answer is that no one has found a way to uniformly and reliably cleanse the entire colon. Considerable progress, nevertheless, has been made and the future of colonic cytology is bright. Historically, as far back as the 1860s body ejecta were examined for exfoliated mal ignant cells. 13 T h e difficulties encountered in collecting, staining and interpreting the material were overwhelming. Taking courage from the success of cytologic studies in other areas, a few proctologists, surgeons and cytologists began cytologic studies anew, and by 1952 a few reports 1, s, 9, 10 were published. When the lesion was not visible, malignant cells were obtained from the exudate pooled distal to sigmoidal lesions in five of 19 cases of WissemanlS and associates and in one of 19 cancers studied by Blank

The Clinical Value of the Negative Gastrointestinal Exfoliative Cytologic Examination in Cancer Suspects

Summary 1. A correlative study was made of the roentgen findings of 1714 gastrointestinal cancer suspects who had negative exfoliative cytologic examinations. All were proven to be clinically free of cancer. The negative cytologic examination, properly performed, significantly excluded the presence of cancer of the digestive tract, with the exception of the pancreas and biliary tract. 2. Notable benign conditions clinically simulating malignancy are esophagitis, gastric ulcer, antral gastritis, large gastric rugae, biliary and pancreatic diseases, ulcerative colitis, diverticulitis, and polyps of the colon. 3. Diagnostic cytologic inaccuracy for the various malignancies of the esophagus, stomach, and colon is approximately 10 per cent. The incidence of diagnostic error for benign conditions (including those considered premalignant) of the gastrointestinal tract is a fraction of 1 per cent. A negative cytologic report has definite clinical value.

Application of exfoliative cytology to benign and malignant diseases of the esophagus and stomach

SummaryThe technical considerations in the performance of gastrointestinal exfoliative cytology, though seemingly minor, pay large dividends in diagnostic accuracy. Conscientious application of the methods and sufficient care in the interpretation help make the exfoliative cytologic procedure the most accurate clinical method for both identifying and excluding the presence of malignant disease in the upper digestive tract.