Concordance between Brush Cytology and Histopathology in diagnosing Gastrointestinal Malignancies: Observations from Rural Medical College

Abstract Background: Gastrointestinal (GI) cancers remain a critical concern in global healthcare, representing a significant portion of cancer-related complications and fatalities. These malignancies make up roughly 25% of cancer cases worldwide. A concerning trend has emerged, particularly in East Asia, where there is a noticeable increase in the incidence of colorectal cancers among younger individuals. The diagnosis of GI cancers is typically delayed due to the nonspecific nature of symptoms, often leading to diagnosis at advanced stages. Although endoscopic biopsy, followed by histopathological examination, remains the primary method for diagnosing gastrointestinal cancers, brush cytology has become a valuable complementary technique for the early detection of these malignancies. Aim: The study aims to assess the effectiveness of brush cytology in identifying gastrointestinal cancers and to determine its level of agreement with histopathological results for malignancies in both the upper and lower gastrointestinal tract. Materials and Methods: A two-year, observational study (both retrospective and prospective) was conducted at a rural medical college in Western Maharashtra, India. A total of 66 patients suspected of having GI malignancies underwent both video-endoscopic examination and concurrent brush cytology and histopathological sampling. The study focused on patients presenting with lesions in the oesophagus, stomach, and colon. Sensitivity, specificity, accuracy, and cytohistological discordance were evaluated. Results: Brush cytology demonstrated an overall sensitivity of 84.7%, a specificity of 71.4%, and an accuracy rate of 83.3% for diagnosis. The study revealed significant discrepancies between cytological and histological diagnoses, particularly in gastroesophageal lesions, highlighting challenges in differentiating squamous cell carcinoma (SCC) from reactive or regenerative changes. Conclusion: Video-endoscopic brush cytology offers a quick, safe, and reliable complementary method for diagnosing GI malignancies. It enhances diagnostic accuracy when combined with histopathological evaluation, facilitating timely management decisions for patients with suspected malignancies.