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. 2014 Dec;2(6):475-81.
doi: 10.1177/2050640614552315.

Accuracy of liquid cytology in the diagnosis and monitoring of eosinophilic oesophagitis

Joaquín Rodríguez-Sánchez  1 , Marcial García Rojo  2 , Bartolomé López Viedma  1 , Eva de la Santa Belda  1 , Pilar Olivencia Palomar  1 , Elisa Gómez Torrijos  3 , Lucia González López  4 , José Olmedo Camacho  1
Affiliations

Accuracy of liquid cytology in the diagnosis and monitoring of eosinophilic oesophagitis

Joaquín Rodríguez-Sánchez et al. United European Gastroenterol J. 2014 Dec.

Abstract

Background: Oesophagoscopy with biopsy is considered the gold standard for diagnosing and monitoring eosinophilic oesophagitis (EoE). Therefore is important to discover less-invasive diagnostic methods.

Methods: Cytology specimens were obtained in patients with active EoE (AEoE) (≥15 eos/hpf) and EoE in remission (EoER) (<15 eos/hpf). The samples were assessed by two independent pathologists and were compared with biopsy samples. EoE cytology specimens were compared with specimens obtained from patients with GERD.

Results: Specimens of 36 patients (69.4% male, mean age 30.88 years) were included. AEoE (17, 47.2%), EoER (11, 30.5%) and GERD (22.2%). eos/hpf in cytology (AEoE 9.23 vs. EoER 1.54 vs. GERD 2, p = 0.01). Linear correlation between eos/hpf average biopsy and cytology eos/hpf: r = 0.57, p < 0.001. For diagnosis of EoE ≥3 eos/hpf in cytology obtained a sensitivity of 70%, specificity 81%, PPV 86% and NPV 60% (AUC = 0.81, p = 0.01). For detection of AEoE, ≥3 eos/hpf in LBC obtained a sensitivity of 70%, specificity 82%, PPV 81% and NPV 66% (AUC = 0.87, p = 0.001).

Conclusions: LBC in oesophageal aspirate seems to be effective for the diagnosis and monitoring activity in EoE. These results support the usefulness of non-invasive methods for the diagnosis and monitoring of EoE.

Keywords: Cytosponge; Eosinophilic esophagitis; GERD; cytology; eosinophil.

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Figures

Figure 1.
Figure 1.
Oesophageal aspiration device (Mocstrap, Covidiem™) adapted to the extraction system of a 9.2 mm gauge gastroscope (GIF-Q165, Olympus, Germany).
Figure 2.
Figure 2.
Cytology sample of an eosinophilic oesophagitis (EoE) patient. Cluster epithelial cells (black arrow) surrounded by more than 30 eosinophils (red arrow) with other cell subsets (yellow arrow) (lymphocytes and polymorphonuclear neutrophils) (20 ×).
Figure 3.
Figure 3.
Inflammatory cells count in oesophageal cytology. *Analysis of variance (ANOVA) test.
Figure 4.
Figure 4.
ROC curves of the different cell populations in the oesophageal LBC. a) ROC curve for diagnostic yield of EoE (eos/hpf (purple line) AUC = 0.835 (95% CI, 0.64–1); p = 0.008). b) ROC curve diagnostic yield for the determination of the activity in EoE (eos/hpf (purple line) AUC = 0.866 (95% CI, 0.73–0.99); p = 0.001). ROC: receiver-operating characteristic; LBC: liquid-based cytology; eos/hpf: eosinophils/high-power field; AUC: area under the curve; CI: confidence interval.
Figure 5.
Figure 5.
Comparison between histology and cytology findings. AEoE (≥15 eos/hpf in histology samples), EoER (<15 eos/hpf in histology samples), Cytology (+) (> 3 eos/hpf in cytology samples) and Cytology (–) (<3 eos/hpf in cytology samples). (p = 0.01, RR = 8.69; 95% CI (1.53 to 50)). *Chi square test. AEoE: active eosinophilic oesophagitis; Eos/hpf: eosinophils/high-power field; EoER: eosinophilic oesophagitis in remission; RR: relative risk; CI: confidence interval
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