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document
Prospective comparison of the value of brushings before and after biopsy in the endoscopic diagnosis of gastroesophageal malignancy . The hypothesis that the cytodiagnostic results on endoscopic brushings obtained before biopsy may be superior to those brushings obtained after biopsy , but with the accuracy of the subsequent biopsy reduced , was examined for 300 consecutive patients , including 256 with esophageal or gastric carcinomas . Following stratification by site and endoscopic appearance of their lesions , the patients were randomized to undergo brushing either before or after forceps biopsy . The accuracy of brushing cytology in patients with carcinoma was significantly higher when the brushing was performed before biopsy than after biopsy ( 93.5 % versus 82.6 % ; P less than .01 ) . The diagnostic yield of the biopsy was not significantly different whether the lesions were brushed before or after the biopsy ( 92.7 % versus 93.2 % ; P less than .5 ) . The diagnostic superiority of brushings obtained before biopsy did not relate to the site or endoscopic appearance of the tumor . There were no false-positive cytologic or histologic reports . For all 256 carcinomas , the cumulative accuracy ( brushing cytology plus biopsy ) reached 98.8 % and was significantly better ( P less than .001 ) than that of biopsy alone ( 93.9 % ) or cytology alone ( 87.9 % ) . Apart from reinforcing the belief that the combined application of brushing and biopsy is mandatory for achieving optimal results , this study indicated that the brushing should be performed before the biopsy .
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Intervention_Physical
brushings before and after biopsy
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Intervention_Physical
endoscopic brushings
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Intervention_Surgical
brushings
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Intervention_Physical
undergo brushing either before or after forceps biopsy .
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Intervention_Physical
brushing cytology
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Intervention_Surgical
brushings obtained before biopsy
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Intervention_Surgical
( brushing cytology plus biopsy )
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Intervention_Surgical
biopsy alone
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Intervention_Surgical
cytology alone
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Intervention_Physical
combined application of brushing and biopsy
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Outcome_Other
accuracy
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Outcome_Other
brushing cytology
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Outcome_Other
diagnostic yield
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Outcome_Other
no false-positive cytologic or histologic reports
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Outcome_Other
cumulative accuracy
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Participant_Condition
gastroesophageal malignancy .
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Participant_Sample-size
300
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Participant_Sample-size
256
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Participant_Condition
esophageal or gastric carcinomas
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Participant_Condition
carcinoma